=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801381017
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RYAN SEIN C LEE DDS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2018
-----------------------------------------------------
Last Update Date | 06/29/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11230 GARVEY AVE STE H
-----------------------------------------------------
City | EL MONTE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91733-2475
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-401-1235
-----------------------------------------------------
Fax | 626-401-1239
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11230 GARVEY AVE STE H
-----------------------------------------------------
City | EL MONTE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91733-2475
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-401-1235
-----------------------------------------------------
Fax | 626-401-1239
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER DENTIST
-----------------------------------------------------
Name | RYAN SEIN LEE
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 626-401-1235
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 41594
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------