Healthcare Provider Details

I. General information

NPI: 1619894367
Provider Name (Legal Business Name): HYEYUN LEE D.D.S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17352 MAIN ST
HESPERIA CA
92345-6153
US

IV. Provider business mailing address

12870 SALMON CT
RANCHO CUCAMONGA CA
91739-2623
US

V. Phone/Fax

Practice location:
  • Phone: 818-731-9898
  • Fax:
Mailing address:
  • Phone: 818-731-9898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. HYEYUN LEE
Title or Position: PRESIDENT
Credential: DDS
Phone: 818-731-9898