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General NPI Number Information
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NPI Number | 1871403006
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Entity Type | Organization
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Legal Business Name | DONG SUP LEE DMD INC.
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Dates
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Enumeration Date | 09/10/2026
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Last Update Date | 09/10/2026
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Provider Practice Location Address
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Address Line | 26640 WESTERN AVE STE I
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City | HARBOR CITY
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State | CA
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Zip | 90710-3659
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Country | US
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Telephone | 310-325-8111
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Fax |
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Provider Business Mailing Address
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Address Line | 446 W CENTRAL AVE
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City | BREA
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State | CA
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Zip | 92821
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Country | US
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Telephone | 804-928-4695
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DONG SUP LEE
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Credential | DMD
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Telephone | 804-928-4695
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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 |
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License Number State |
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