Healthcare Provider Details

I. General information

NPI: 1043844889
Provider Name (Legal Business Name): NICOLE SANG-AH LEE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2020
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 SCOTT BLVD STE D1
SANTA CLARA CA
95050-4547
US

IV. Provider business mailing address

1150 SCOTT BLVD STE D1
SANTA CLARA CA
95050-4547
US

V. Phone/Fax

Practice location:
  • Phone: 408-248-9597
  • Fax:
Mailing address:
  • Phone: 408-248-9597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number206406
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: