Provider Demographics
NPI:1578667697
Name:CARE DENTAL OFFICE
Entity Type:Organization
Organization Name:CARE DENTAL OFFICE
Other - Org Name:SANG M LEE DDS INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANG
Authorized Official - Middle Name:MYUNG
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-860-9000
Mailing Address - Street 1:5985 E FLORENCE AVE
Mailing Address - Street 2:#F
Mailing Address - City:BELL GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90201
Mailing Address - Country:US
Mailing Address - Phone:323-560-9000
Mailing Address - Fax:323-560-9001
Practice Address - Street 1:5985 E FLORENCE AVE
Practice Address - Street 2:#F
Practice Address - City:BELL GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90201
Practice Address - Country:US
Practice Address - Phone:323-560-9000
Practice Address - Fax:323-560-9001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47511122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G9265201Medicare ID - Type Unspecified