Provider Demographics
NPI:1417532276
Name:LAM LEE, MIKI CHU (RN, CDCES)
Entity Type:Individual
Prefix:
First Name:MIKI
Middle Name:CHU
Last Name:LAM LEE
Suffix:
Gender:F
Credentials:RN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 140063
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75014-0063
Mailing Address - Country:US
Mailing Address - Phone:312-933-0761
Mailing Address - Fax:
Practice Address - Street 1:3900 TELEPORT BLVD UNIT 140063
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75014-0017
Practice Address - Country:US
Practice Address - Phone:312-933-0671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-13
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041410077163WD0400X
AZ267957163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL000000000Medicaid