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General NPI Number Information
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NPI Number | 1710670450
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Entity Type | Organization
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Legal Business Name | DONGGEUN LEE, D.D.S., INC.
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Dates
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Enumeration Date | 05/30/2023
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Last Update Date | 12/12/2023
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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 | 213-800-1228
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Fax |
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Provider Business Mailing 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 | 626-388-2621
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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. DONGGEUN LEE
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Credential |
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Telephone | 213-800-1228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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