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General NPI Number Information
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NPI Number | 1639240294
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Entity Type | Individual
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Provider Name | JEAN LEE-MIRZAYAN D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 04/24/2013
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Provider Practice Location Address
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Address Line | 1080 WILSHIRE BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90017-2416
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Country | US
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Telephone | 213-553-4535
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Fax | 213-330-0295
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Provider Business Mailing Address
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Address Line | 1080 WILSHIRE BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90017-2416
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Country | US
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Telephone | 213-553-4535
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Fax | 213-330-0295
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 46403
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License Number State | CA
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