MEDICARE: LUKE C.K. LEE D.D.S.

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	29342	CA

General Provider Information

NPI Number	:	1437366408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUKE C.K. LEE D.D.S.

Provider Business Mailing Address
First Line	:	1514 STRAWFLOWER LN.
Second Line	:
City	:	DIAMOND BAR
State	:	CA
Zip	:	91765-3041
Country	:	US
Telephone Number	:	909-860-3906
Fax Number	:

Provider Business Practice Location Address
First Line	:	18761 COLIMA RD
Second Line	:
City	:	ROWLAND HEIGHTS
State	:	CA
Zip	:	91748-2949
Country	:	US
Telephone Number	:	626-965-5411
Fax Number	:

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

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/08/2007

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