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General NPI Number Information
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NPI Number | 1104579291
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Entity Type | Organization
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Legal Business Name | SUN MOON & STARS MEDICAL CORPORATION
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Dates
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Enumeration Date | 01/30/2022
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Last Update Date | 01/30/2022
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Provider Practice Location Address
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Address Line | 1363 DONLON ST STE 13
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City | VENTURA
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State | CA
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Zip | 93003-5638
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Country | US
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Telephone | 805-330-0706
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Fax |
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Provider Business Mailing Address
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Address Line | 1363 DONLON ST STE 13
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City | VENTURA
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State | CA
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Zip | 93003-5638
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Country | US
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Telephone | 805-330-0706
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. SUN MOON LEE
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Credential | MD
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Telephone | 805-330-0706
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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