Healthcare Provider Details

I. General information

NPI: 1821210378
Provider Name (Legal Business Name): HO-JHIN JONATHAN LEE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9310 CARMEL MOUNTAIN RD SUITE A
SAN DIEGO CA
92129-2158
US

IV. Provider business mailing address

9310 CARMEL MOUNTAIN RD SUITE A
SAN DIEGO CA
92129-2158
US

V. Phone/Fax

Practice location:
  • Phone: 858-484-4880
  • Fax: 858-484-3029
Mailing address:
  • Phone: 858-484-4880
  • Fax: 858-484-3029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number56834
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3695
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: