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General NPI Number Information
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NPI Number | 1902045677
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Entity Type | Individual
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Provider Name | SHAWN LEE D.D.S
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Gender | Male
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Dates
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Enumeration Date | 02/19/2009
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Last Update Date | 06/20/2016
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Provider Practice Location Address
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Address Line | 13450 HAWTHORNE BLVD
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City | HAWTHORNE
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State | CA
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Zip | 90250-5806
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Country | US
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Telephone | 310-679-0106
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Fax | 310-679-6698
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Provider Business Mailing Address
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Address Line | 28901 S WESTERN AVE STE 135
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City | RANCHO PALOS VERDES
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State | CA
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Zip | 90275-0824
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Country | US
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Telephone | 310-750-2470
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Fax | 310-817-6068
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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 | 57783
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License Number State | CA
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