Provider Demographics
NPI:1598908469
Name:LEE, ANDRE MYONGSON (DDS)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:MYONGSON
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 1:2707 W OLYMPIC BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2859
Mailing Address - Country:US
Mailing Address - Phone:213-382-4336
Mailing Address - Fax:213-382-4993
Practice Address - Street 1:2707 W OLYMPIC BLVD STE 202
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2859
Practice Address - Country:US
Practice Address - Phone:213-382-4336
Practice Address - Fax:213-382-4993
Is Sole Proprietor?:No
Enumeration Date:2009-04-08
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56635122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist