Provider Demographics
NPI:1497157697
Name:LEE AND SAMBANGI DENTAL CORPORATION
Entity Type:Organization
Organization Name:LEE AND SAMBANGI DENTAL CORPORATION
Other - Org Name:CLAREMONT MODERN DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SOOJIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-626-1236
Mailing Address - Street 1:17000 RED HILL AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-5626
Mailing Address - Country:US
Mailing Address - Phone:714-845-8890
Mailing Address - Fax:949-474-1495
Practice Address - Street 1:405 W FOOTHILL BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-2786
Practice Address - Country:US
Practice Address - Phone:909-626-1236
Practice Address - Fax:909-626-1242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty