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General NPI Number Information
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NPI Number | 1770835316
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Entity Type | Individual
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Provider Name | HAE YOUNG LEE D.D.S
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Gender | Female
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Dates
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Enumeration Date | 10/05/2012
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Last Update Date | 10/05/2012
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Provider Practice Location Address
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Address Line | 2058 MAYA DR.
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City | KINGMAN
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State | AZ
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Zip | 86401
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Country | US
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Telephone | 928-377-3205
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Fax |
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Provider Business Mailing Address
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Address Line | 2058 MAYA DR
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City | KINGMAN
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State | AZ
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Zip | 86401-6501
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Country | US
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Telephone | 928-377-3205
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Fax |
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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 | 019029251
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401413773
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License Number State | VA
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