MEDICARE: DR. RUY TSUN LEE DDS

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	122300000X	Dentist	31059	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D31059	OTHER	CA	DENTI-CAL RENDERPROVIDER
2	G94163-01	OTHER	CA	DENTI-CAL BILLINGPROVIDER

General Provider Information

NPI Number	:	1184760373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUY TSUN LEE DDS

Provider Business Mailing Address
First Line	:	1008 EAST LAS TUNAS DRIVE
Second Line	:	SUITE D
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-1615
Country	:	US
Telephone Number	:	626-287-5988
Fax Number	:

Provider Business Practice Location Address
First Line	:	1008 EAST LAS TUNAS DRIVE
Second Line	:	SUITE D
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-1615
Country	:	US
Telephone Number	:	626-287-5988
Fax Number	:

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	07/08/2007

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