Provider Demographics
NPI:1871639948
Name:LEE, SANG-MOK SAMUEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:SANG-MOK
Middle Name:SAMUEL
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 1:18391 COLIMA RD STE 209
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-2730
Mailing Address - Country:US
Mailing Address - Phone:626-854-2100
Mailing Address - Fax:626-854-2102
Practice Address - Street 1:9862 CHAPMAN AVE STE B
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-2726
Practice Address - Country:US
Practice Address - Phone:714-537-9380
Practice Address - Fax:714-537-2593
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA536231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice