MEDICARE: ALEXANDER LEE

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	390200000X	Student in an Organized Health Care Education/Training Program
2	1223G0001X	General Practice Dentistry	104692	CA

General Provider Information

NPI Number	:	1528529278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER LEE

Provider Business Mailing Address
First Line	:	7911 E SANTA CRUZ AVE
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92869-5649
Country	:	US
Telephone Number	:	408-480-3219
Fax Number	:

Provider Business Practice Location Address
First Line	:	13792 BEAR VALLEY RD STE 1
Second Line	:
City	:	VICTORVILLE
State	:	CA
Zip	:	92392-8713
Country	:	US
Telephone Number	:	760-245-2010
Fax Number	:

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

Provider Enumeration Date	:	03/26/2019
Last Update Date	:	07/31/2020

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Directions to “ ALEXANDER LEE ” Practice Location

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