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General NPI Number Information
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NPI Number | 1467509646
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Entity Type | Individual
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Provider Name | LUKE BYUNG CHUL LEE DDS
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Gender | Male
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 06/28/2010
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Provider Practice Location Address
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Address Line | 3400 LOMA VISTA RD SUITE 11
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City | VENTURA
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State | CA
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Zip | 93003-3033
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Country | US
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Telephone | 805-639-9205
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Fax | 805-639-9230
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Provider Business Mailing Address
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Address Line | 3400 LOMA VISTA RD SUITE 11
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City | VENTURA
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State | CA
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Zip | 93003-3033
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Country | US
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Telephone | 805-639-9205
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Fax | 805-639-9230
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 55251
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License Number State | CA
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