Healthcare Provider Details

I. General information

NPI: 1114847340
Provider Name (Legal Business Name): DR. HANS C LEE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10286 INDIANA AVE
RIVERSIDE CA
92503-5357
US

IV. Provider business mailing address

2689 ANNAPOLIS CIR
SAN BERNARDINO CA
92408-4167
US

V. Phone/Fax

Practice location:
  • Phone: 951-359-5200
  • Fax:
Mailing address:
  • Phone: 678-409-1863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113418
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: