Provider Demographics
NPI:1619227352
Name:LEE, PAUL CHONG CHAN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:CHONG CHAN
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:DR
Other - First Name:CHONG CHAN
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1111 S GRAND AVE APT 706
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-2169
Mailing Address - Country:US
Mailing Address - Phone:661-993-7347
Mailing Address - Fax:
Practice Address - Street 1:933 S SUNSET AVE STE 208
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3410
Practice Address - Country:US
Practice Address - Phone:626-600-6080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039221122300000X
CA610571223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist