Healthcare Provider Details

I. General information

NPI: 1639738016
Provider Name (Legal Business Name): ALEX CRISTOPHER LEE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6416 SANTA FE AVE
HUNTINGTON PARK CA
90255-3808
US

IV. Provider business mailing address

3701 HOMELAND DR
VIEW PARK CA
90008-4921
US

V. Phone/Fax

Practice location:
  • Phone: 213-399-4711
  • Fax:
Mailing address:
  • Phone: 213-399-4711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number103738
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: