MEDICARE: DR. YON I SAMANTHA 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	52884	CA

General Provider Information

NPI Number	:	1851415202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YON I SAMANTHA LEE D.D.S.

Provider Business Mailing Address
First Line	:	1822 PROFESSIONAL DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95825-2107
Country	:	US
Telephone Number	:	916-483-5100
Fax Number	:	916-483-5620

Provider Business Practice Location Address
First Line	:	1822 PROFESSIONAL DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95825-2107
Country	:	US
Telephone Number	:	916-483-5100
Fax Number	:	916-483-5620

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

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	05/23/2014

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