Provider Demographics
NPI:1356694442
Name:LEE, ESTHER KIM (DMD)
Entity type:Individual
Prefix:DR
First Name:ESTHER
Middle Name:KIM
Last Name:LEE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10620 COSTELLO DR
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-1403
Mailing Address - Country:US
Mailing Address - Phone:714-747-8400
Mailing Address - Fax:
Practice Address - Street 1:2790 CABOT DR
Practice Address - Street 2:SUITE 160
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92883-7380
Practice Address - Country:US
Practice Address - Phone:951-277-2416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA599241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice