Healthcare Provider Details

I. General information

NPI: 1386703692
Provider Name (Legal Business Name): YUNG LEE OD, DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 W CHANDLER BLVD SUITE 1124
CHANDLER AZ
85226-5071
US

IV. Provider business mailing address

11103 WEST AVE SUITE 6
SAN ANTONIO TX
78213-1370
US

V. Phone/Fax

Practice location:
  • Phone: 480-782-9380
  • Fax:
Mailing address:
  • Phone: 210-524-6509
  • Fax: 210-524-6587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7366
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1583
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: