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General NPI Number Information
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NPI Number | 1083775696
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Entity Type | Individual
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Provider Name | SUSAN J LEE D.M.D., M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 18372 CLARK ST SUITE 224
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City | TARZANA
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State | CA
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Zip | 91356-3508
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Country | US
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Telephone | 818-996-1200
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Fax | 818-996-1325
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Provider Business Mailing Address
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Address Line | 18372 CLARK ST SUITE 224
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City | TARZANA
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State | CA
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Zip | 91356-3508
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Country | US
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Telephone | 818-996-1200
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Fax | 818-996-1325
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | A94671
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | A94671
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License Number State | CA
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