Provider Demographics
NPI:1598159220
Name:LEE, DAVID JUNG LI (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JUNG LI
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9543 BROADWAY
Mailing Address - Street 2:#4
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-3163
Mailing Address - Country:US
Mailing Address - Phone:626-287-3385
Mailing Address - Fax:
Practice Address - Street 1:10 E HUNTINGTON DR
Practice Address - Street 2:SUITE D
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3249
Practice Address - Country:US
Practice Address - Phone:626-821-0169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA387091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice