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General NPI Number Information
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NPI Number | 1265602783
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Entity Type | Organization
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Legal Business Name | LEE, WEE& BAEK.DDS.INC
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Dates
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Enumeration Date | 03/12/2008
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Last Update Date | 03/12/2008
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Provider Practice Location Address
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Address Line | 61325 29 PALMS HWY STE A
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City | JOSHUA TREE
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State | CA
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Zip | 92252-1912
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Country | US
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Telephone | 760-366-0420
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Fax | 760-360-0520
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Provider Business Mailing Address
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Address Line | 61325 29 PALMS HWY STE A
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City | JOSHUA TREE
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State | CA
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Zip | 92252-1912
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Country | US
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Telephone | 760-366-0420
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Fax | 760-360-0520
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Authorized Official
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Title or Position | SECRETARY
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Name | JIN NAM BAEK
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Credential | D.D.S
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Telephone | 951-756-0069
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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 | 54709
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License Number State | CA
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