MEDICARE: KANG HOON LEE, D.D.S., INC.

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
1	1223G0001X	General Practice Dentistry	26460	CA

General Provider Information

NPI Number	:	1093902595
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KANG HOON LEE, D.D.S., INC.

Provider Business Mailing Address
First Line	:	1661 NOGALES ST STE C
Second Line	:
City	:	ROWLAND HEIGHTS
State	:	CA
Zip	:	91748-2987
Country	:	US
Telephone Number	:	626-912-8557
Fax Number	:

Provider Business Practice Location Address
First Line	:	1661 NOGALES ST STE C
Second Line	:
City	:	ROWLAND HEIGHTS
State	:	CA
Zip	:	91748-2987
Country	:	US
Telephone Number	:	626-912-8557
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. KANG HOON LEE
Credential	:	D.D.S.
Telephone Number	:	626-912-8557

Provider Enumeration Date	:	09/27/2007
Last Update Date	:	09/27/2007

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