Healthcare Provider Details

I. General information

NPI: 1679492763
Provider Name (Legal Business Name): JUSTIN MIN WOO LEE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 W AVENUE J STE 103
LANCASTER CA
93534-2850
US

IV. Provider business mailing address

1629 W AVENUE J STE 103
LANCASTER CA
93534-2850
US

V. Phone/Fax

Practice location:
  • Phone: 661-948-7722
  • Fax:
Mailing address:
  • Phone: 661-948-7722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113168
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: