Healthcare Provider Details

I. General information

NPI: 1740530849
Provider Name (Legal Business Name): STEPHANIE PUI NING LEE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2012
Last Update Date: 10/24/2022
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S EL MOLINO AVE STE 6
PASADENA CA
91101-2985
US

IV. Provider business mailing address

200 S EL MOLINO AVE STE 6
PASADENA CA
91101-2985
US

V. Phone/Fax

Practice location:
  • Phone: 626-795-0221
  • Fax:
Mailing address:
  • Phone: 626-795-0221
  • Fax: 626-795-3813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number62171
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: