Provider Demographics
NPI:1205323391
Name:BYUN LEE AND PATEL A DENTAL CORPORATION
Entity type:Organization
Organization Name:BYUN LEE AND PATEL A DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:JUNG WOOK
Authorized Official - Middle Name:
Authorized Official - Last Name:BYUN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-878-6680
Mailing Address - Street 1:1313 W 17TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-3308
Mailing Address - Country:US
Mailing Address - Phone:714-568-1600
Mailing Address - Fax:
Practice Address - Street 1:1313 W 17TH ST STE B
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-3308
Practice Address - Country:US
Practice Address - Phone:714-568-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA547171223G0001X
CA610571223X0400X
CA487071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1801936968Medicaid
CA1104960574Medicaid
CA1619227352Medicaid