Provider Demographics
NPI:1053077669
Name:KATHERINE J LEE DMD INC
Entity Type:Organization
Organization Name:KATHERINE J LEE DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:JY-SHIUAN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:626-321-3919
Mailing Address - Street 1:909 S SANTA ANITA AVE STE D
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-2312
Mailing Address - Country:US
Mailing Address - Phone:626-623-6388
Mailing Address - Fax:
Practice Address - Street 1:909 S SANTA ANITA AVE STE D
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-2312
Practice Address - Country:US
Practice Address - Phone:626-623-6388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty