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General NPI Number Information
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NPI Number | 1699452821
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Entity Type | Organization
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Legal Business Name | KI LEE DENTAL CORP.
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Dates
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Enumeration Date | 06/29/2023
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Last Update Date | 07/05/2023
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Provider Practice Location Address
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Address Line | 11900 SOUTH ST STE 122
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City | CERRITOS
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State | CA
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Zip | 90703-6800
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Country | US
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Telephone | 562-809-6177
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Fax | 562-809-7659
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Provider Business Mailing Address
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Address Line | 11900 SOUTH ST STE 122
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City | CERRITOS
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State | CA
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Zip | 90703-6800
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Country | US
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Telephone | 562-809-6177
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Fax | 562-809-7659
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Authorized Official
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Title or Position | DENTIST
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Name | KI BAEK LEE
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Credential | DDS
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Telephone | 323-880-3704
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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 |
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License Number State |
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