MEDICARE: DR. PETER YOUNG LEE DMD

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	122300000X	Dentist	54078	CA

General Provider Information

NPI Number	:	1699771154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER YOUNG LEE DMD

Provider Business Mailing Address
First Line	:	2795 W LINCOLN AVE STE D
Second Line	:	STE D
City	:	ANAHEIM
State	:	CA
Zip	:	92801-6334
Country	:	US
Telephone Number	:	714-229-8553
Fax Number	:

Provider Business Practice Location Address
First Line	:	2668 MONTEREY PL
Second Line	:
City	:	FULLERTON
State	:	CA
Zip	:	92833-2086
Country	:	US
Telephone Number	:	714-363-6173
Fax Number	:

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	03/11/2008

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