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General NPI Number Information
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NPI Number | 1528707197
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Entity Type | Organization
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Legal Business Name | KEVIN K. LEE DENTAL CORPORATION
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Dates
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Enumeration Date | 06/01/2022
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Last Update Date | 06/01/2022
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Provider Practice Location Address
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Address Line | 255 W CENTRAL AVE STE 101
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City | BREA
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State | CA
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Zip | 92821-3373
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Country | US
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Telephone | 714-529-5999
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Fax |
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Provider Business Mailing Address
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Address Line | 8755 E CLOUDVIEW WAY
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City | ANAHEIM
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State | CA
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Zip | 92808-1658
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Country | US
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Telephone | 408-464-8950
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KEVIN LEE
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Credential | DDS
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Telephone | 408-464-8950
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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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