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NPI Code Detail

MEDICARE: SOONKI LEE DDS PC

MEDICARE: SOONKI LEE DDS PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223S0112XOral and Maxillofacial Surgery (Dentist)DDS62164CA

General Provider Information

NPI Number : 1033618681
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOONKI LEE DDS PC
Provider Business Mailing Address
First Line : 3030 W OLYMPIC BLVD STE 216
Second Line :
City : LOS ANGELES
State : CA
Zip : 90006-6507
Country : US
Telephone Number : 213-384-1036
Fax Number :
Provider Business Practice Location Address
First Line : 3030 W OLYMPIC BLVD STE 216
Second Line :
City : LOS ANGELES
State : CA
Zip : 90006-6507
Country : US
Telephone Number : 213-384-1036
Fax Number :
Authorized Official
Title or Position : OWNER
Name : SOONKI LEE
Credential : DDS
Telephone Number : 213-384-1036
Provider Enumeration Date : 02/09/2018
Last Update Date : 09/13/2018

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