Provider Demographics
NPI:1841417391
Name:LEE, SUSAN THUYMINH (D D S)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:THUYMINH
Last Name:LEE
Suffix:
Gender:F
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2726 ABORN RD
Mailing Address - Street 2:STE. K
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-1276
Mailing Address - Country:US
Mailing Address - Phone:408-270-7723
Mailing Address - Fax:408-223-8717
Practice Address - Street 1:2726 ABORN RD
Practice Address - Street 2:STE. K
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-1276
Practice Address - Country:US
Practice Address - Phone:408-270-7723
Practice Address - Fax:408-223-8717
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47750122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93237-01OtherDENTI-CAL