Provider Demographics
NPI:1437793445
Name:BAAG, LEE & CHUNG DENTAL CORP.
Entity Type:Organization
Organization Name:BAAG, LEE & CHUNG DENTAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIN
Authorized Official - Middle Name:HO
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:323-737-1001
Mailing Address - Street 1:3224 W OLYMPIC BLVD # 201
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2317
Mailing Address - Country:US
Mailing Address - Phone:323-737-1001
Mailing Address - Fax:
Practice Address - Street 1:3224 W OLYMPIC BLVD # 201
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2317
Practice Address - Country:US
Practice Address - Phone:323-737-1001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-01
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental