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General NPI Number Information
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NPI Number | 1245943950
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Entity Type | Organization
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Legal Business Name | SANGMOO LEE DDS INC
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Dates
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Enumeration Date | 12/28/2022
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Last Update Date | 12/28/2022
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Provider Practice Location Address
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Address Line | 3030 W 8TH ST STE 305
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City | LOS ANGELES
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State | CA
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Zip | 90005-1870
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Country | US
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Telephone | 213-384-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 1450 FULBRIGHT AVE
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City | REDLANDS
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State | CA
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Zip | 92373-4938
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Country | US
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Telephone | 909-435-9509
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SANGMOO LEE
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Credential | DDS
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Telephone | 909-435-9509
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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