Provider Demographics
NPI:1912029323
Name:LEE AND YOUNG ORTHODONTICS
Entity Type:Organization
Organization Name:LEE AND YOUNG ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-751-1700
Mailing Address - Street 1:3501 CALIFORNIA ST
Mailing Address - Street 2:#202
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1707
Mailing Address - Country:US
Mailing Address - Phone:415-751-1700
Mailing Address - Fax:415-751-1700
Practice Address - Street 1:3501 CALIFORNIA ST
Practice Address - Street 2:#202
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1707
Practice Address - Country:US
Practice Address - Phone:415-751-1700
Practice Address - Fax:415-751-1700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320111223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty