Provider Demographics
NPI:1689850315
Name:LEE, SANG EUN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SANG
Middle Name:EUN
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:SANG
Other - Middle Name:EUN
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2600 HIGHLAND AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-2179
Mailing Address - Country:US
Mailing Address - Phone:909-851-7323
Mailing Address - Fax:
Practice Address - Street 1:2600 HIGHLAND AVE
Practice Address - Street 2:SUITE B
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-2179
Practice Address - Country:US
Practice Address - Phone:909-851-7323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA554511223G0001X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice