1609197532 NPI number — DR. FRANK FANG-CHUNG LEE DO

Table of content: DR. FRANK FANG-CHUNG LEE DO (NPI 1609197532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609197532 NPI number — DR. FRANK FANG-CHUNG LEE DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
FRANK
Provider Middle Name:
FANG-CHUNG
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609197532
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1505 WIGWAM PKWY STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89074-8195
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-485-5000
Provider Business Mailing Address Fax Number:
702-485-5001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9100 W POST RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89148-2418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-896-6043
Provider Business Practice Location Address Fax Number:
702-896-9591
Provider Enumeration Date:
06/15/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  SL0726 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1609197532 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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