Healthcare Provider Details

I. General information

NPI: 1275101750
Provider Name (Legal Business Name): DONGGEUN LEE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15785 LAGUNA CANYON RD STE 240
IRVINE CA
92618-3166
US

IV. Provider business mailing address

48 LOWLAND
IRVINE CA
92602-0837
US

V. Phone/Fax

Practice location:
  • Phone: 949-556-0557
  • Fax:
Mailing address:
  • Phone: 213-800-1228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number101355
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: