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General NPI Number Information
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NPI Number | 1396374211
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Entity Type | Organization
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Legal Business Name | HYUN SUK LEE DDS INC
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Dates
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Enumeration Date | 04/02/2020
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Last Update Date | 04/02/2020
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Provider Practice Location Address
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Address Line | 2523 S SAN PEDRO ST
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City | LOS ANGELES
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State | CA
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Zip | 90011-1519
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Country | US
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Telephone | 213-441-7704
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Fax |
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Provider Business Mailing Address
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Address Line | 633 N CENTRAL AVE APT 425
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City | GLENDALE
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State | CA
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Zip | 91203-1852
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Country | US
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Telephone | 213-215-1475
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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. HYUN SUK LEE
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Credential | DDS
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Telephone | 213-215-1475
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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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