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General NPI Number Information
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NPI Number | 1588247175
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Entity Type | Individual
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Provider Name | LEE MIYAUCHI DDS
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Gender | Male
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Dates
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Enumeration Date | 04/30/2021
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Last Update Date | 07/06/2022
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Provider Practice Location Address
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Address Line | 654 W 4TH ST # A
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City | SAN BERNARDINO
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State | CA
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Zip | 92410-3216
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Country | US
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Telephone | 909-693-4103
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Fax |
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Provider Business Mailing Address
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Address Line | 7051 ANGORA ST
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City | CHINO
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State | CA
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Zip | 91710-8332
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Country | US
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Telephone | 323-631-7797
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 105219
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License Number State | CA
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