Provider Demographics
NPI:1790793388
Name:LEE, PETER KIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:KIN
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 1:15814 WINCHESTER BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-3333
Mailing Address - Country:US
Mailing Address - Phone:408-399-3920
Mailing Address - Fax:408-399-3918
Practice Address - Street 1:15814 WINCHESTER BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-3333
Practice Address - Country:US
Practice Address - Phone:408-399-3920
Practice Address - Fax:408-399-3918
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47749122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist