Provider Demographics
NPI:1497970354
Name:SUSAN THUYMINH LEE D.D. S . INC.
Entity Type:Organization
Organization Name:SUSAN THUYMINH LEE D.D. S . INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:THUYMINH
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:D D S
Authorized Official - Phone:916-371-8455
Mailing Address - Street 1:970 SACRAMENTO AVE
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95605-1904
Mailing Address - Country:US
Mailing Address - Phone:916-371-8455
Mailing Address - Fax:
Practice Address - Street 1:970 SACRAMENTO AVE
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95605-1904
Practice Address - Country:US
Practice Address - Phone:916-371-8455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47750122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty