Provider Demographics
NPI:1134664808
Name:JS LEE, DDS, INC
Entity Type:Organization
Organization Name:JS LEE, DDS, INC
Other - Org Name:DENTAL GROUP OF ANAHEIM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEE
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:7814-743-3067
Mailing Address - Street 1:50 S ANAHEIM BLVD
Mailing Address - Street 2:#94
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-2931
Mailing Address - Country:US
Mailing Address - Phone:714-635-5500
Mailing Address - Fax:
Practice Address - Street 1:50 S ANAHEIM BLVD
Practice Address - Street 2:#94
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-2931
Practice Address - Country:US
Practice Address - Phone:714-635-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA473871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty