Provider Demographics
NPI:1407618390
Name:JONATHAN K. LEE DDS, APC
Entity Type:Organization
Organization Name:JONATHAN K. LEE DDS, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-500-9647
Mailing Address - Street 1:2218 W BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-2302
Mailing Address - Country:US
Mailing Address - Phone:310-500-9647
Mailing Address - Fax:323-477-1362
Practice Address - Street 1:2218 W BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-2302
Practice Address - Country:US
Practice Address - Phone:310-500-9647
Practice Address - Fax:323-477-1362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental