Provider Demographics
NPI:1346699253
Name:LEE, MICHAEL CHENG SHIAO
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CHENG SHIAO
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 1:15924 BELLFLOWER BLVD
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-4602
Mailing Address - Country:US
Mailing Address - Phone:562-925-5314
Mailing Address - Fax:562-925-7924
Practice Address - Street 1:15924 BELLFLOWER BLVD
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-4602
Practice Address - Country:US
Practice Address - Phone:562-925-5314
Practice Address - Fax:562-925-7924
Is Sole Proprietor?:No
Enumeration Date:2016-06-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72106183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist