Provider Demographics
NPI:1588716120
Name:LEE, LEON YAN SHAW (OMD)
Entity type:Individual
Prefix:MR
First Name:LEON
Middle Name:YAN SHAW
Last Name:LEE
Suffix:
Gender:M
Credentials:OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 MATLOCK RD
Mailing Address - Street 2:#101
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-5258
Mailing Address - Country:US
Mailing Address - Phone:817-274-3627
Mailing Address - Fax:817-303-6554
Practice Address - Street 1:4300 MATLOCK RD
Practice Address - Street 2:#101
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-5258
Practice Address - Country:US
Practice Address - Phone:817-274-3627
Practice Address - Fax:817-303-6554
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00344171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist