Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 53238 | CA |
NPI | 1003818782 |
---|---|
Provider Name | Dr. Yun S. Lee |
First Address | Los Angeles, CA 90010-2401 |
Second Address | Los Angeles, CA 90010-2401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2005 |
Last Update Date | 27/08/2007 |