Healthcare Provider Details

I. General information

NPI: 1912724097
Provider Name (Legal Business Name): LEE AND HA DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2024
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9209 COLIMA RD STE 3300
WHITTIER CA
90605-1818
US

IV. Provider business mailing address

9209 COLIMA RD STE 3300
WHITTIER CA
90605-1818
US

V. Phone/Fax

Practice location:
  • Phone: 562-464-0555
  • Fax: 562-464-0559
Mailing address:
  • Phone: 562-464-0555
  • Fax: 562-464-0559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH LEE
Title or Position: OWNER
Credential: DDS
Phone: 901-900-8200