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General NPI Number Information
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NPI Number | 1205323391
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Entity Type | Organization
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Legal Business Name | BYUN LEE AND PATEL A DENTAL CORPORATION
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Dates
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Enumeration Date | 04/16/2018
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Last Update Date | 04/16/2018
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Provider Practice Location Address
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Address Line | 1313 W 17TH ST STE B
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City | SANTA ANA
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State | CA
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Zip | 92706-3308
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Country | US
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Telephone | 714-568-1600
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Fax |
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Provider Business Mailing Address
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Address Line | 1313 W 17TH ST STE B
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City | SANTA ANA
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State | CA
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Zip | 92706-3308
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Country | US
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Telephone | 714-568-1600
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | DR. JUNG WOOK BYUN
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Credential | DDS
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Telephone | 949-878-6680
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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 | 54717
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 61057
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 48707
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License Number State | CA
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