=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609930585
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SANGLIM LEE PETERS DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2006
-----------------------------------------------------
Last Update Date | 11/05/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 W COLUMBUS ST #200
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93301-1200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-325-9466
-----------------------------------------------------
Fax | 661-325-0706
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6420 SAN ROGUE CT
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93312-5912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-302-8121
-----------------------------------------------------
Fax | 661-302-8121
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 53182
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------