Healthcare Provider Details

I. General information

NPI: 1588078661
Provider Name (Legal Business Name): JULIA LEE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 09/18/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10715 S PRAIRIE AVE
INGLEWOOD CA
90303-2113
US

IV. Provider business mailing address

10715 S PRAIRIE AVE
INGLEWOOD CA
90303-2113
US

V. Phone/Fax

Practice location:
  • Phone: 310-419-6463
  • Fax:
Mailing address:
  • Phone: 310-419-6463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS105416
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401415854
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS040863
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN1001777
License Number StateDC
# 5
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number057329
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: