MEDICARE: DR. ERINA LEE D.D.S

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
1	1223G0001X	General Practice Dentistry	57063	CA

General Provider Information

NPI Number	:	1467690636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERINA LEE D.D.S

Provider Business Mailing Address
First Line	:	2020 CAMINO DE LA REINA
Second Line	:	#117
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-5522
Country	:	US
Telephone Number	:	909-556-9850
Fax Number	:	619-269-7176

Provider Business Practice Location Address
First Line	:	2020 CAMINO DE LA REINA
Second Line	:	#117
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-5522
Country	:	US
Telephone Number	:	909-556-9850
Fax Number	:	619-269-7176

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2009
Last Update Date	:	01/27/2009

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