MEDICARE: DR. SEPI LEE DDS

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	101846	CA

General Provider Information

NPI Number	:	1548786247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEPI LEE DDS

Provider Business Mailing Address
First Line	:	1122 E LINCOLN AVE STE 209
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92865-1909
Country	:	US
Telephone Number	:	714-637-1600
Fax Number	:

Provider Business Practice Location Address
First Line	:	1122 E LINCOLN AVE STE 209
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92865-1909
Country	:	US
Telephone Number	:	714-637-1600
Fax Number	:

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

Provider Enumeration Date	:	08/15/2017
Last Update Date	:	04/26/2021

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