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General NPI Number Information
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NPI Number | 1730578923
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Entity Type | Individual
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Provider Name | SO YEON LEE D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 01/12/2015
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Last Update Date | 01/19/2017
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Provider Practice Location Address
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Address Line | 820 LOCUST ST #3013
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City | PASADENA
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State | CA
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Zip | 91101-5611
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Country | US
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Telephone | 310-999-2196
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Fax | 323-477-2139
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Provider Business Mailing Address
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Address Line | 820 LOCUST ST #3013
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City | PASADENA
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State | CA
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Zip | 91101-5611
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Country | US
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Telephone | 310-999-2196
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Fax | 323-477-2139
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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 | 64253
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License Number State | CA
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