MEDICARE: KANG HOON LEE DDS 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	122300000X	Dentist	26460	CA

General Provider Information

NPI Number	:	1245492206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KANG HOON LEE DDS 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	:	DDS
Telephone Number	:	626-912-8557

Provider Enumeration Date	:	06/30/2008
Last Update Date	:	06/30/2008

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