Provider Demographics
NPI:1417106162
Name:LEE, HEIDI HIU MAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:HIU MAN
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1049 COCHRANE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-9081
Mailing Address - Country:US
Mailing Address - Phone:408-778-4440
Mailing Address - Fax:
Practice Address - Street 1:1049 COCHRANE RD STE 110
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-9081
Practice Address - Country:US
Practice Address - Phone:408-778-4440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57637122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist