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NPI Code Detail

MEDICARE: CHANGWOO LEE DDS

MEDICARE: CHANGWOO LEE DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry110111CA

General Provider Information

NPI Number : 1124849914
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHANGWOO LEE DDS
Provider Business Mailing Address
First Line : 3129 N SAN FERNANDO RD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90065-1412
Country : US
Telephone Number : 323-257-7744
Fax Number : 323-257-5430
Provider Business Practice Location Address
First Line : 3129 N SAN FERNANDO RD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90065-1412
Country : US
Telephone Number : 323-257-7744
Fax Number : 323-257-5430
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2024
Last Update Date : 03/02/2026

Similar Medicare Providers

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Directions to “ CHANGWOO LEE DDS” Practice Location

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