Provider Demographics
NPI:1861251944
Name:LEE, CHENG TA
Entity type:Individual
Prefix:
First Name:CHENG
Middle Name:TA
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 1:1151 153RD LN NE
Mailing Address - Street 2:
Mailing Address - City:HAM LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55304-5502
Mailing Address - Country:US
Mailing Address - Phone:651-399-3266
Mailing Address - Fax:
Practice Address - Street 1:1151 153RD LN NE
Practice Address - Street 2:
Practice Address - City:HAM LAKE
Practice Address - State:MN
Practice Address - Zip Code:55304-5502
Practice Address - Country:US
Practice Address - Phone:651-399-3266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care