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General NPI Number Information
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NPI Number | 1861603573
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Entity Type | Individual
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Provider Name | KWANG BACK LEE DDS
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Gender | Male
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 08/26/2008
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Provider Practice Location Address
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Address Line | 4015 WILSHIRE BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90010-3401
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Country | US
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Telephone | 213-385-1325
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Fax | 213-380-9842
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Provider Business Mailing Address
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Address Line | 920 JASMINE PARKE DR #2
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City | BAKERSFIELD
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State | CA
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Zip | 93312-2287
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Country | US
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Telephone | 213-718-2926
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 55099
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License Number State | CA
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