Healthcare Provider Details

I. General information

NPI: 1588288591
Provider Name (Legal Business Name): KIM & LEE A DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2020
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1686 W KATELLA AVE
ANAHEIM CA
92802-3015
US

IV. Provider business mailing address

2046 ARTS AVE
BREA CA
92821-6161
US

V. Phone/Fax

Practice location:
  • Phone: 657-655-4321
  • Fax:
Mailing address:
  • Phone: 503-360-8886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LINDA MEE YOUNG LEE
Title or Position: CEO
Credential: DDS
Phone: 503-360-8886