Provider Demographics
NPI:1508373002
Name:KI BAEK LEE, DDS. INC.
Entity Type:Organization
Organization Name:KI BAEK LEE, DDS. INC.
Other - Org Name:K SMILE DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KI
Authorized Official - Middle Name:BAEK
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-773-2082
Mailing Address - Street 1:6501 EASTERN AVE.
Mailing Address - Street 2:#B
Mailing Address - City:BELL GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90201
Mailing Address - Country:US
Mailing Address - Phone:323-773-2082
Mailing Address - Fax:323-560-3905
Practice Address - Street 1:6501 EASTERN AVE.
Practice Address - Street 2:#B
Practice Address - City:BELL GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90201
Practice Address - Country:US
Practice Address - Phone:323-773-2082
Practice Address - Fax:323-560-3905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-05
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA594191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty