Provider Demographics
NPI:1326738287
Name:DENTAL GROUP OF SUNG Y LEE DMD INC
Entity Type:Organization
Organization Name:DENTAL GROUP OF SUNG Y LEE DMD INC
Other - Org Name:E-DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:310-787-1233
Mailing Address - Street 1:3174 E GAGE AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-5346
Mailing Address - Country:US
Mailing Address - Phone:323-581-3011
Mailing Address - Fax:323-581-3011
Practice Address - Street 1:3174 E GAGE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-5346
Practice Address - Country:US
Practice Address - Phone:323-581-3011
Practice Address - Fax:323-581-3011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-12
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental