Healthcare Provider Details

I. General information

NPI: 1346772878
Provider Name (Legal Business Name): ALEXANDER LEE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15422 CRENSHAW BLVD
GARDENA CA
90249-4524
US

IV. Provider business mailing address

15422 CRENSHAW BLVD
GARDENA CA
90249-4524
US

V. Phone/Fax

Practice location:
  • Phone: 310-352-3949
  • Fax:
Mailing address:
  • Phone: 415-531-1813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberGRADUATION 05/2017
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number102433
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: