MEDICARE: JUNG YEOL LEE DMD 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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1184341216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUNG YEOL LEE DMD INC

Provider Business Mailing Address
First Line	:	10431 LEMON AVE STE K
Second Line	:
City	:	ALTA LOMA
State	:	CA
Zip	:	91737-3766
Country	:	US
Telephone Number	:	909-476-8303
Fax Number	:

Provider Business Practice Location Address
First Line	:	10431 LEMON AVE STE K
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91737-3766
Country	:	US
Telephone Number	:	909-476-8303
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JUNG LEE
Credential	:	DMD
Telephone Number	:	661-670-9443

Provider Enumeration Date	:	10/19/2022
Last Update Date	:	10/25/2022

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Directions to “JUNG YEOL LEE DMD INC ” Practice Location

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