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General NPI Number Information
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NPI Number | 1851884886
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Entity Type | Organization
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Legal Business Name | SHAUNA R. LEE, DDS DENTAL CORPORATION
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Dates
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Enumeration Date | 06/13/2018
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Last Update Date | 06/13/2018
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Provider Practice Location Address
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Address Line | 4146 E OLYMPIC BLVD STE F
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City | LOS ANGELES
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State | CA
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Zip | 90023-3347
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Country | US
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Telephone | 323-269-8007
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Fax | 323-269-2720
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Provider Business Mailing Address
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Address Line | 4146 E OLYMPIC BLVD STE F
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City | LOS ANGELES
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State | CA
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Zip | 90023-3347
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Country | US
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Telephone | 323-269-8007
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Fax | 323-269-2720
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Authorized Official
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Title or Position | CEO
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Name | DR. SHAUNA R. LEE
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Credential | DDS
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Telephone | 323-269-8007
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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 | 39030
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License Number State | CA
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