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General NPI Number Information
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NPI Number | 1659182632
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Entity Type | Organization
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Legal Business Name | JAMES JAEHYUNG LEE DENTAL COPORATION
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Dates
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Enumeration Date | 01/17/2025
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Last Update Date | 01/17/2025
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Provider Practice Location Address
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Address Line | 178 S VICTORIA AVE STE B
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City | VENTURA
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State | CA
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Zip | 93003-4368
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Country | US
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Telephone | 805-642-8165
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Fax |
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Provider Business Mailing Address
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Address Line | 178 S VICTORIA AVE STE B
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City | VENTURA
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State | CA
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Zip | 93003-4368
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Country | US
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Telephone | 805-642-8165
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | JAMES JAEHYUNG LEE
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Credential | DDS
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Telephone | 909-499-9678
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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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