Provider Demographics
NPI:1407028509
Name:LEE, HIN PONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:HIN PONG
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22912 PACIFIC PARK DR STE A
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-5328
Mailing Address - Country:US
Mailing Address - Phone:949-716-6900
Mailing Address - Fax:949-716-9888
Practice Address - Street 1:22912 PACIFIC PARK DR STE A
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-5328
Practice Address - Country:US
Practice Address - Phone:949-716-6900
Practice Address - Fax:949-716-9888
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA512791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice