Healthcare Provider Details

I. General information

NPI: 1215516232
Provider Name (Legal Business Name): SHIN & LEE DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 E IMPERIAL HWY # B8-207
LYNWOOD CA
90262-3223
US

IV. Provider business mailing address

3150 E IMPERIAL HWY # B8-207
LYNWOOD CA
90262-3223
US

V. Phone/Fax

Practice location:
  • Phone: 909-800-1994
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GUNDONG LEE
Title or Position: SECRETARY
Credential: DDS
Phone: 909-800-1994