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General NPI Number Information
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NPI Number | 1033942677
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Entity Type | Organization
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Legal Business Name | JACOB K LEE, DDS, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 08/20/2024
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Last Update Date | 08/20/2024
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Provider Practice Location Address
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Address Line | 28242 AIROSO ST
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City | RANCHO MISSION VIEJO
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State | CA
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Zip | 92694-1878
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Country | US
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Telephone | 949-242-0070
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Fax |
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Provider Business Mailing Address
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Address Line | 28242 AIROSO ST
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City | RANCHO MISSION VIEJO
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State | CA
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Zip | 92694-1878
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Country | US
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Telephone | 949-242-0070
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | JACOB LEE
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Credential | DDS
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Telephone | 949-242-0070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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