Provider Demographics
NPI:1497991483
Name:LEE, BYONG-HWI (DMD)
Entity Type:Individual
Prefix:DR
First Name:BYONG-HWI
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 VIA ARBOLADA UNIT 313
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-5073
Mailing Address - Country:US
Mailing Address - Phone:714-213-0958
Mailing Address - Fax:
Practice Address - Street 1:2650 S BRISTOL ST
Practice Address - Street 2:SUITE107
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-5751
Practice Address - Country:US
Practice Address - Phone:714-213-0958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-23
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA573881223G0001X
NMDD30921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM9218384OtherDENTAQUEST
NM13570072Medicaid