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General NPI Number Information
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NPI Number | 1861582801
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Entity Type | Individual
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Provider Name | SEONG WOOK LEE D.M.D
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Gender | Male
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 09/22/2022
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Provider Practice Location Address
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Address Line | 11438 KENYON WAY # 3C
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91701-9230
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Country | US
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Telephone | 909-945-5262
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Fax |
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Provider Business Mailing Address
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Address Line | 501 LAKESIDE DR
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City | FULLERTON
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State | CA
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Zip | 92835-1509
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Country | US
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Telephone | 714-351-7875
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | S7-128
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 54854
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License Number State | CA
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