Healthcare Provider Details

I. General information

NPI: 1831335579
Provider Name (Legal Business Name): SUSAN THUYMINH LEE D.D.S. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2008
Last Update Date: 12/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2726 ABORN RD
SAN JOSE CA
95121-1276
US

IV. Provider business mailing address

2726 ABORN RD
SAN JOSE CA
95121-1276
US

V. Phone/Fax

Practice location:
  • Phone: 408-270-7723
  • Fax: 408-223-8717
Mailing address:
  • Phone: 408-270-7723
  • Fax: 408-223-8717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number47750
License Number StateCA

VIII. Authorized Official

Name: MRS. SUSAN THUYMINH LEE
Title or Position: OWNER
Credential: DDS
Phone: 408-270-7723