Provider Demographics
NPI:1437600434
Name:LEE, VIVIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4420 W SARAH ST
Mailing Address - Street 2:APT #12
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-3812
Mailing Address - Country:US
Mailing Address - Phone:206-375-9287
Mailing Address - Fax:
Practice Address - Street 1:8300 VALLEY CIRCLE BLVD
Practice Address - Street 2:STE B
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91304-3023
Practice Address - Country:US
Practice Address - Phone:818-348-6068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100782122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist