Provider Demographics
NPI:1942553748
Name:LEE, MIN HYUN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MIN
Middle Name:HYUN
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 1:801 S GRAND AVE APT 1711
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-4673
Mailing Address - Country:US
Mailing Address - Phone:646-256-5759
Mailing Address - Fax:
Practice Address - Street 1:801 S GRAND AVE APT 1711
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4673
Practice Address - Country:US
Practice Address - Phone:646-256-5759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA619381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice