MEDICARE: ESTHER 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
1	122300000X	Dentist	107328	CA

General Provider Information

NPI Number	:	1730768755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ESTHER LEE DDS

Provider Business Mailing Address
First Line	:	6551 LONGMONT AVE
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91775-1723
Country	:	US
Telephone Number	:	408-892-3684
Fax Number	:

Provider Business Practice Location Address
First Line	:	4531 PHILADELPHIA ST STE B107
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-2249
Country	:	US
Telephone Number	:	909-325-7095
Fax Number	:

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

Provider Enumeration Date	:	04/06/2021
Last Update Date	:	07/13/2022

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