Healthcare Provider Details

I. General information

NPI: 1598229635
Provider Name (Legal Business Name): ESTHER KIM LEE DMD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2019
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 N HARBOR BLVD
FULLERTON CA
92832-1310
US

IV. Provider business mailing address

2050 N ACACIA AVE
FULLERTON CA
92831-1259
US

V. Phone/Fax

Practice location:
  • Phone: 714-784-0844
  • Fax:
Mailing address:
  • Phone: 714-747-8400
  • 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 Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ESTHER KIM LEE
Title or Position: PRESIDENT
Credential: DMD
Phone: 714-747-8400