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NPI Code Detail

MEDICARE: SOONKI LEE DMD

MEDICARE: SOONKI LEE DMD
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
11223G0001XGeneral Practice Dentistry62164CA

General Provider Information

NPI Number : 1255688214
Entity Type Code : Individual
Provider Name (Legal Business Name) : SOONKI LEE DMD
Provider Business Mailing Address
First Line : 3030 W OLYMPIC BLVD STE 216
Second Line :
City : LOS ANGELES
State : CA
Zip : 90006-6507
Country : US
Telephone Number : 213-384-1036
Fax Number :
Provider Business Practice Location Address
First Line : 3030 W OLYMPIC BLVD STE 216
Second Line :
City : LOS ANGELES
State : CA
Zip : 90006-6507
Country : US
Telephone Number : 213-384-1036
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2012
Last Update Date : 02/05/2018

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Directions to “ SOONKI LEE DMD” Practice Location

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