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General NPI Number Information
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NPI Number | 1194251306
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Entity Type | Organization
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Legal Business Name | JU Y LEE DENTAL CORPORATION
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Dates
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Enumeration Date | 05/08/2017
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Last Update Date | 05/31/2018
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Provider Practice Location Address
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Address Line | 1096 IRVINE BLVD
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City | TUSTIN
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State | CA
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Zip | 92780
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Country | US
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Telephone | 714-838-2875
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Fax | 714-838-2887
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Provider Business Mailing Address
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Address Line | 1096 IRVINE BLVD
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City | TUSTIN
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State | CA
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Zip | 92780-3527
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Country | US
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Telephone | 714-838-2875
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Fax | 714-838-2887
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Authorized Official
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Title or Position | DENTIST
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Name | JUYOUNG LEE
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Credential | D.D.S.
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Telephone | 714-838-2875
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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 | 61258
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License Number State | CA
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