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General NPI Number Information
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NPI Number | 1700265048
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Entity Type | Organization
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Legal Business Name | J LEE DDS INC
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Dates
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Enumeration Date | 05/20/2015
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Last Update Date | 05/20/2015
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Provider Practice Location Address
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Address Line | 6581 FOOTHILL BLVD
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City | TUJUNGA
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State | CA
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Zip | 91042-2728
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Country | US
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Telephone | 818-353-1123
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Fax |
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Provider Business Mailing Address
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Address Line | 6581 FOOTHILL BLVD
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City | TUJUNGA
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State | CA
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Zip | 91042-2728
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEAN LEE
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Credential | DDS
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Telephone | 415-806-1176
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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 | 56137
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License Number State | CA
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