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General NPI Number Information
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NPI Number | 1174945794
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Entity Type | Organization
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Legal Business Name | BYONG HWI LEE, D.D.S, INC
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Dates
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Enumeration Date | 01/16/2014
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Last Update Date | 01/26/2014
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Provider Practice Location Address
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Address Line | 2650 S BRISTOL ST SUITE 107
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City | SANTA ANA
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State | CA
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Zip | 92704-5751
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Country | US
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Telephone | 714-213-0958
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Fax |
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Provider Business Mailing Address
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Address Line | 2650 S BRISTOL ST SUITE 107
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City | SANTA ANA
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State | CA
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Zip | 92704-5751
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Country | US
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Telephone | 714-213-0958
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | BYONG HWI LEE
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Credential | DDS
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Telephone | 714-213-0958
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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 | 57388
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License Number State | CA
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