Provider Demographics
NPI:1396862728
Name:LEE, ANDREW YONG-JIN (MD,DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:YONG-JIN
Last Name:LEE
Suffix:
Gender:M
Credentials:MD,DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12860 10TH STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-4294
Mailing Address - Country:US
Mailing Address - Phone:909-591-0241
Mailing Address - Fax:909-591-1691
Practice Address - Street 1:12860 10TH STREET
Practice Address - Street 2:SUITE A
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-4294
Practice Address - Country:US
Practice Address - Phone:909-591-0241
Practice Address - Fax:909-591-1691
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOMS321223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery