Provider Demographics
NPI:1902045677
Name:LEE, SHAWN (DDS)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
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 1:28901 S WESTERN AVE STE 135
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-0824
Mailing Address - Country:US
Mailing Address - Phone:310-750-2470
Mailing Address - Fax:310-817-6068
Practice Address - Street 1:13450 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-5806
Practice Address - Country:US
Practice Address - Phone:310-679-0106
Practice Address - Fax:310-679-6698
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-19
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57783122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist