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General NPI Number Information
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NPI Number | 1619227352
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Entity Type | Individual
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Provider Name | PAUL CHONG CHAN LEE DDS, MS
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Gender | Male
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Dates
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Enumeration Date | 09/10/2012
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Last Update Date | 10/04/2017
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Provider Practice Location Address
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Address Line | 933 S SUNSET AVE STE 208
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City | WEST COVINA
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State | CA
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Zip | 91790-3410
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Country | US
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Telephone | 626-600-6080
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 S GRAND AVE APT 706
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City | LOS ANGELES
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State | CA
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Zip | 90015-2169
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Country | US
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Telephone | 661-993-7347
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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 | DS039221
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 61057
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License Number State | CA
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