MEDICARE: DR. KWANG BACK 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	55099	CA

General Provider Information

NPI Number	:	1861603573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KWANG BACK LEE DDS

Provider Business Mailing Address
First Line	:	920 JASMINE PARKE DR
Second Line	:	#2
City	:	BAKERSFIELD
State	:	CA
Zip	:	93312-2287
Country	:	US
Telephone Number	:	213-718-2926
Fax Number	:

Provider Business Practice Location Address
First Line	:	4015 WILSHIRE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-3401
Country	:	US
Telephone Number	:	213-385-1325
Fax Number	:	213-380-9842

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	08/26/2008

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Directions to “ DR. KWANG BACK LEE DDS” Practice Location

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