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General NPI Number Information
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NPI Number | 1225430473
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Entity Type | Organization
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Legal Business Name | RYAN S C LEE,A PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 09/18/2014
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Last Update Date | 09/18/2014
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Provider Practice Location Address
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Address Line | 2111 S ATLANTIC BLVD
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City | MONTEREY PARK
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State | CA
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Zip | 91754-6801
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Country | US
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Telephone | 323-261-9999
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Fax | 323-260-7680
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Provider Business Mailing Address
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Address Line | 2111 S ATLANTIC BLVD
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City | MONTEREY PARK
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State | CA
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Zip | 91754-6801
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Country | US
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Telephone | 323-261-9999
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Fax | 323-260-7680
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RYAN S C LEE
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Credential | DDS
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Telephone | 323-261-9999
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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 | 41594
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License Number State | CA
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