Healthcare Provider Details

I. General information

NPI: 1700265048
Provider Name (Legal Business Name): J LEE DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2015
Last Update Date: 05/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6581 FOOTHILL BLVD
TUJUNGA CA
91042-2728
US

IV. Provider business mailing address

6581 FOOTHILL BLVD
TUJUNGA CA
91042-2728
US

V. Phone/Fax

Practice location:
  • Phone: 818-353-1123
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number56137
License Number StateCA

VIII. Authorized Official

Name: DR. JEAN LEE
Title or Position: PRESIDENT
Credential: DDS
Phone: 415-806-1176