Provider Demographics
NPI:1134515265
Name:LEE, ANDREW WONJOO (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:WONJOO
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30212 TOMAS
Mailing Address - Street 2:SUITE 165
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-2172
Mailing Address - Country:US
Mailing Address - Phone:949-766-0034
Mailing Address - Fax:
Practice Address - Street 1:30212 TOMAS
Practice Address - Street 2:SUITE 165
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-2172
Practice Address - Country:US
Practice Address - Phone:949-766-0034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-15
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA491341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice