Healthcare Provider Details

I. General information

NPI: 1760022511
Provider Name (Legal Business Name): SUNG Y. LEE DMD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9950 LONG BEACH BLVD
LYNWOOD CA
90262-1503
US

IV. Provider business mailing address

1757 W CARSON ST STE E
TORRANCE CA
90501-2828
US

V. Phone/Fax

Practice location:
  • Phone: 323-923-9700
  • Fax: 323-923-9712
Mailing address:
  • Phone: 310-787-1233
  • Fax: 310-787-1239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. SUNG YOUNG LEE
Title or Position: CEO
Credential: DMD
Phone: 714-722-1222