Healthcare Provider Details

I. General information

NPI: 1710670450
Provider Name (Legal Business Name): DONGGEUN LEE, D.D.S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2023
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

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. DONGGEUN LEE
Title or Position: PRESIDENT
Credential: DDS
Phone: 213-800-1228