Provider Demographics
NPI:1326102013
Name:HYUN CHAN LEE
Entity Type:Organization
Organization Name:HYUN CHAN LEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:HYUN CHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:562-402-8060
Mailing Address - Street 1:12137 CARSON ST
Mailing Address - Street 2:
Mailing Address - City:HAWAIIAN GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90716-1154
Mailing Address - Country:US
Mailing Address - Phone:562-402-8060
Mailing Address - Fax:562-809-1552
Practice Address - Street 1:12137 E CARSON ST
Practice Address - Street 2:
Practice Address - City:HAWAIIAN GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90716
Practice Address - Country:US
Practice Address - Phone:562-402-8060
Practice Address - Fax:562-809-1552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD41455122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty