Provider Demographics
NPI:1437656709
Name:LEE, JENNIFER TRAN (DMD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:TRAN
Last Name:LEE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:THI
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:11977 SYCAMORE LN
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1603
Mailing Address - Country:US
Mailing Address - Phone:408-390-0800
Mailing Address - Fax:
Practice Address - Street 1:1330 N GLASSELL ST STE E
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-3628
Practice Address - Country:US
Practice Address - Phone:714-997-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-12
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103609122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist