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General NPI Number Information
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NPI Number | 1588288591
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Entity Type | Organization
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Legal Business Name | KIM & LEE A DENTAL CORPORATION
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Dates
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Enumeration Date | 06/04/2020
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Last Update Date | 11/30/2021
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Provider Practice Location Address
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Address Line | 1686 W KATELLA AVE
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City | ANAHEIM
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State | CA
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Zip | 92802-3015
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Country | US
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Telephone | 657-655-4321
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Fax |
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Provider Business Mailing Address
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Address Line | 2046 ARTS AVE
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City | BREA
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State | CA
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Zip | 92821-6161
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Country | US
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Telephone | 503-360-8886
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LINDA MEE YOUNG LEE
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Credential | DDS
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Telephone | 503-360-8886
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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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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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