Provider Demographics
NPI:1558568527
Name:HONG AND LEE DENTAL CORPORATION
Entity Type:Organization
Organization Name:HONG AND LEE DENTAL CORPORATION
Other - Org Name:FULLERTON PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:SANG
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:714-992-5437
Mailing Address - Street 1:100 E VALENCIA MESA DR
Mailing Address - Street 2:STE 102
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835
Mailing Address - Country:US
Mailing Address - Phone:714-992-5437
Mailing Address - Fax:714-870-3085
Practice Address - Street 1:100 E VALENCIA MESA DR
Practice Address - Street 2:STE 102
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835
Practice Address - Country:US
Practice Address - Phone:714-992-5437
Practice Address - Fax:714-870-3085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA448071223P0221X
CA373351223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9229301Medicare UPIN