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General NPI Number Information
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NPI Number | 1508137142
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Entity Type | Organization
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Legal Business Name | WONJOO LEE, DDS, INC.
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Dates
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Enumeration Date | 01/12/2012
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Last Update Date | 01/12/2012
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Provider Practice Location Address
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Address Line | 3540 GRAND AVE SUITE 100
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City | OAKLAND
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State | CA
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Zip | 94610-2010
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Country | US
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Telephone | 510-208-3012
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Fax | 510-208-4524
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Provider Business Mailing Address
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Address Line | 3540 GRAND AVE SUITE 100
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City | OAKLAND
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State | CA
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Zip | 94610-2010
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Country | US
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Telephone | 510-208-3012
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Fax | 510-208-4524
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WONJOO LEE
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Credential |
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Telephone | 510-208-3012
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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 | 49923
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License Number State | CA
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