Provider Demographics
NPI:1851784268
Name:LEE, ALEXANDER WOORAM SCOTT SHIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:WOORAM SCOTT SHIN
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:WOO RAM
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2010 ZONAL AVE, BUILDING B
Mailing Address - Street 2:5P77
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1987
Mailing Address - Country:US
Mailing Address - Phone:215-834-2709
Mailing Address - Fax:
Practice Address - Street 1:2010 ZONAL AVE. BLDG. B,
Practice Address - Street 2:#5P77
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033
Practice Address - Country:US
Practice Address - Phone:215-834-2709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-09
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA653621223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry