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General NPI Number Information
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NPI Number | 1962173583
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Entity Type | Individual
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Provider Name | GAEUN LEE DDS
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Gender | Female
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Dates
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Enumeration Date | 09/23/2021
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Last Update Date | 09/24/2022
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Provider Practice Location Address
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Address Line | 1809 VERDUGO BLVD STE 270
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City | GLENDALE
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State | CA
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Zip | 91208-1419
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Country | US
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Telephone | 818-952-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 1809 VERDUGO BLVD STE 270
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City | GLENDALE
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State | CA
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Zip | 91208-1419
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Country | US
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Telephone | 915-472-3223
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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 | DN1859278
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DDS106989
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License Number State | CA
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