MEDICARE: DR. HSIN-JUEI GRACE LEE D.D.S

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	1223P0221X	Pediatric Dentistry	50077	CA

General Provider Information

NPI Number	:	1134343486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HSIN-JUEI GRACE LEE D.D.S

Provider Business Mailing Address
First Line	:	601 SILVER SPUR RD
Second Line	:
City	:	ROLLING HILLS ESTATES
State	:	CA
Zip	:	90274-3601
Country	:	US
Telephone Number	:	310-377-4551
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 SILVER SPUR ROAD
Second Line	:
City	:	ROLLING HILLS ESTATES
State	:	CA
Zip	:	90274-3601
Country	:	US
Telephone Number	:	310-377-4551
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	07/08/2007

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