Provider Demographics
NPI:1396208567
Name:LEE, LOO UN (DMD)
Entity Type:Individual
Prefix:DR
First Name:LOO UN
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19510 VAN BUREN BLVD STE F5
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-9458
Mailing Address - Country:US
Mailing Address - Phone:951-653-6663
Mailing Address - Fax:951-656-5638
Practice Address - Street 1:19510 VAN BUREN BLVD STE F5
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-9458
Practice Address - Country:US
Practice Address - Phone:951-653-6663
Practice Address - Fax:951-656-5638
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-12
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA1057981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program