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General NPI Number Information
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NPI Number | 1568916724
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Entity Type | Individual
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Provider Name | DAE SUN LEE
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Gender | Male
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Dates
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Enumeration Date | 08/05/2016
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Last Update Date | 06/02/2023
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Provider Practice Location Address
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Address Line | 7377 S JONES BLVD STE 110
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City | LAS VEGAS
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State | NV
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Zip | 89139-0547
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Country | US
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Telephone | 702-382-2709
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Fax |
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Provider Business Mailing Address
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Address Line | 7377 S JONES BLVD STE 110
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City | LAS VEGAS
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State | NV
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Zip | 89139-0547
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Country | US
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Telephone | 702-382-2709
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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 | 100610
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 113885
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License Number State | AK
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7627
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License Number State | NV
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