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General NPI Number Information
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NPI Number | 1477094795
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Entity Type | Individual
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Provider Name | BRIAN P LEE D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 03/20/2017
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Last Update Date | 08/21/2019
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Provider Practice Location Address
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Address Line | 1616 RANGE CT
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City | DIAMOND BAR
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State | CA
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Zip | 91765-4318
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Country | US
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Telephone | 626-715-6328
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Fax |
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Provider Business Mailing Address
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Address Line | 1616 RANGE CT
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City | DIAMOND BAR
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State | CA
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Zip | 91765-4318
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Country | US
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Telephone | 626-715-6328
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 101822
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 101822
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License Number State | CA
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