Provider Demographics
NPI:1598808453
Name:KYOUNG HEE SUSAN LEE, DDS, INC
Entity Type:Organization
Organization Name:KYOUNG HEE SUSAN LEE, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:KYOUNG HEE
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-255-1010
Mailing Address - Street 1:570 E VIRGINIA WAY
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-3910
Mailing Address - Country:US
Mailing Address - Phone:760-255-1010
Mailing Address - Fax:760-256-6707
Practice Address - Street 1:570 E VIRGINIA WAY
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-3910
Practice Address - Country:US
Practice Address - Phone:760-255-1010
Practice Address - Fax:760-256-6707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49787122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty