Provider Demographics
NPI:1952012684
Name:LEE, CHIA
Entity Type:Individual
Prefix:
First Name:CHIA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1085 SANDRINGHAM WAY
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-5321
Mailing Address - Country:US
Mailing Address - Phone:916-642-7800
Mailing Address - Fax:916-755-4799
Practice Address - Street 1:1085 SANDRINGHAM WAY
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-5321
Practice Address - Country:US
Practice Address - Phone:916-642-7800
Practice Address - Fax:916-755-4799
Is Sole Proprietor?:No
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN179061164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse