Healthcare Provider Details

I. General information

NPI: 1578667697
Provider Name (Legal Business Name): CARE DENTAL OFFICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5985 E FLORENCE AVE #F
BELL GARDENS CA
90201
US

IV. Provider business mailing address

5985 E FLORENCE AVE #F
BELL GARDENS CA
90201
US

V. Phone/Fax

Practice location:
  • Phone: 323-560-9000
  • Fax: 323-560-9001
Mailing address:
  • Phone: 323-560-9000
  • Fax: 323-560-9001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number47511
License Number StateCA

VIII. Authorized Official

Name: SANG MYUNG LEE
Title or Position: PRESIDENT
Credential: DDS
Phone: 323-860-9000