Provider Demographics
NPI:1376174508
Name:EUN SOO LEE DDS INC
Entity Type:Organization
Organization Name:EUN SOO LEE DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EUN SOO
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-406-3826
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-27
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental