Provider Demographics
NPI:1235654096
Name:LEE, EUN SOO (DDS)
Entity Type:Individual
Prefix:
First Name:EUN SOO
Middle Name:
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 1:11818 ROSECRANS AVE STE B
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-4125
Mailing Address - Country:US
Mailing Address - Phone:562-406-3826
Mailing Address - Fax:562-868-4444
Practice Address - Street 1:11818 ROSECRANS AVE STE B
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-4125
Practice Address - Country:US
Practice Address - Phone:562-406-3826
Practice Address - Fax:562-868-4444
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-13
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1016261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice