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General NPI Number Information
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NPI Number | 1548686629
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Entity Type | Organization
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Legal Business Name | JIA Y LEE DDS INC
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Dates
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Enumeration Date | 03/12/2014
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Last Update Date | 03/12/2014
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Provider Practice Location Address
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Address Line | 9477 HAVEN AVE
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-5844
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Country | US
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Telephone | 909-989-5598
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Fax | 909-989-2225
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Provider Business Mailing Address
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Address Line | 9477 HAVEN AVE
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-5844
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Country | US
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Telephone | 909-989-5598
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Fax | 909-989-2225
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JESSICA URBINA
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Credential |
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Telephone | 909-989-5598
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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 | 43358
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License Number State | CA
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