Healthcare Provider Details

I. General information

NPI: 1023939360
Provider Name (Legal Business Name): LEE ANNE GRACE QUIJANO BARANGAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 S CENTRAL AVE
GLENDALE CA
91204-1602
US

IV. Provider business mailing address

14334 LORNE ST
PANORAMA CITY CA
91402-5208
US

V. Phone/Fax

Practice location:
  • Phone: 818-243-3986
  • Fax:
Mailing address:
  • Phone: 213-292-8960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number111983
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: