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General NPI Number Information
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NPI Number | 1316074636
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Entity Type | Organization
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Legal Business Name | LEE AND YOO DENTAL CORPORATION
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 06/26/2008
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Provider Practice Location Address
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Address Line | 1139 NORTH MOUNT VERNON AVE
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City | COLTON
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State | CA
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Zip | 92324
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Country | US
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Telephone | 909-777-5900
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Fax | 909-777-5909
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Provider Business Mailing Address
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Address Line | 1139 NORTH MOUNT VERNON AVE
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City | COLTON
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State | CA
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Zip | 92324
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Country | US
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Telephone | 909-777-5900
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Fax | 909-777-5909
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. KYU HOON LEE
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Credential | DMD
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Telephone | 909-777-5900
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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 | 50772
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 51676
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License Number State | CA
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