MEDICARE: DR. HAN WOOK 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	39831	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B39831-01	OTHER	CA	DENTI-CAL

General Provider Information

NPI Number	:	1932234515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HAN WOOK LEE DDS

Provider Business Mailing Address
First Line	:	1515 W OLYMPIC BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-3803
Country	:	US
Telephone Number	:	213-384-4100
Fax Number	:	213-384-4214

Provider Business Practice Location Address
First Line	:	1515 W OLYMPIC BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-3803
Country	:	US
Telephone Number	:	213-384-4100
Fax Number	:	213-384-4214

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

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	07/08/2007

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