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General NPI Number Information
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NPI Number | 1598808453
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Entity Type | Organization
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Legal Business Name | KYOUNG HEE SUSAN LEE, DDS, INC
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 02/03/2015
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Provider Practice Location Address
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Address Line | 570 E VIRGINIA WAY
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City | BARSTOW
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State | CA
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Zip | 92311-3910
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Country | US
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Telephone | 760-255-1010
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Fax | 760-256-6707
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Provider Business Mailing Address
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Address Line | 570 E VIRGINIA WAY
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City | BARSTOW
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State | CA
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Zip | 92311-3910
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Country | US
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Telephone | 760-255-1010
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Fax | 760-256-6707
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Authorized Official
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Title or Position | DR
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Name | DR. KYOUNG HEE SUSAN LEE
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Credential | DDS
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Telephone | 760-255-1010
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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 | 49787
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License Number State | CA
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