MEDICARE: CHRISTINA MYUNG 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	261QD0000X	Dental Clinic/Center	61900	CA

General Provider Information

NPI Number	:	1487151379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTINA MYUNG DDS, INC.

Provider Business Mailing Address
First Line	:	12009 GARFIELD AVE
Second Line	:
City	:	SOUTH GATE
State	:	CA
Zip	:	90280-7822
Country	:	US
Telephone Number	:	562-630-7777
Fax Number	:

Provider Business Practice Location Address
First Line	:	12009 GARFIELD AVE
Second Line	:
City	:	SOUTH GATE
State	:	CA
Zip	:	90280-7822
Country	:	US
Telephone Number	:	562-630-7777
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHRISTINA SAE HEE LEE
Credential	:	DDS
Telephone Number	:	213-393-6201

Provider Enumeration Date	:	04/09/2018
Last Update Date	:	07/15/2020

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