MEDICARE: SUSAN THUYMINH LEE D.D.S. 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	305R00000X	Preferred Provider Organization	47750	CA

General Provider Information

NPI Number	:	1831335579
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSAN THUYMINH LEE D.D.S. INC

Provider Business Mailing Address
First Line	:	2726 ABORN RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95121-1276
Country	:	US
Telephone Number	:	408-270-7723
Fax Number	:	408-223-8717

Provider Business Practice Location Address
First Line	:	2726 ABORN RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95121-1276
Country	:	US
Telephone Number	:	408-270-7723
Fax Number	:	408-223-8717

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. SUSAN THUYMINH LEE
Credential	:	DDS
Telephone Number	:	408-270-7723

Provider Enumeration Date	:	12/31/2008
Last Update Date	:	12/31/2008

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