Provider Demographics
NPI:1346847258
Name:KWAK-LEE, DAISY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAISY
Middle Name:
Last Name:KWAK-LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 E CHAPMAN AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-2145
Mailing Address - Country:US
Mailing Address - Phone:714-532-0888
Mailing Address - Fax:
Practice Address - Street 1:1110 E CHAPMAN AVE STE 102
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2145
Practice Address - Country:US
Practice Address - Phone:714-532-0888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-04
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1056401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice