MEDICARE: D AND A 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	1223G0001X	General Practice Dentistry	59047	CA
2	1223G0001X	General Practice Dentistry		CA

General Provider Information

NPI Number	:	1326425380
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	D AND A LEE DDS INC

Provider Business Mailing Address
First Line	:	65100 DATE PALM AVE STE L
Second Line	:
City	:	MECCA
State	:	CA
Zip	:	92254-6611
Country	:	US
Telephone Number	:	760-396-3888
Fax Number	:

Provider Business Practice Location Address
First Line	:	65100 DATE PALM AVE STE L
Second Line	:
City	:	MECCA
State	:	CA
Zip	:	92254-6611
Country	:	US
Telephone Number	:	760-396-3888
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	WOO YONG LEE
Credential	:
Telephone Number	:	760-396-3888

Provider Enumeration Date	:	04/29/2015
Last Update Date	:	04/29/2015

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