MEDICARE: DANIEL I. LEE , INC.

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1790989614
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANIEL I. LEE , INC.

Provider Business Mailing Address
First Line	:	4200 CHINO HILLS PKWY
Second Line	:	SUITE 880
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-3776
Country	:	US
Telephone Number	:	909-393-5456
Fax Number	:	909-393-2051

Provider Business Practice Location Address
First Line	:	4200 CHINO HILLS PKWY
Second Line	:	SUITE 880
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-3776
Country	:	US
Telephone Number	:	909-393-5456
Fax Number	:	909-393-2051

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	DR. DANIEL INYOUNG LEE
Credential	:	DDS
Telephone Number	:	909-393-5456

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	08/22/2020

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