Provider Demographics
NPI:1316127558
Name:LEE, TENG J
Entity type:Individual
Prefix:
First Name:TENG
Middle Name:J
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 W OLIVE AVE STE H
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-1900
Mailing Address - Country:US
Mailing Address - Phone:209-725-1295
Mailing Address - Fax:
Practice Address - Street 1:1180 W OLIVE AVE STE H
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-1900
Practice Address - Country:US
Practice Address - Phone:209-725-1295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter