Provider Demographics
NPI:1457558942
Name:LEE, JONATHAN K (DDS)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:K
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 1:3129 N SAN FERNANDO RD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-1412
Mailing Address - Country:US
Mailing Address - Phone:323-257-7744
Mailing Address - Fax:323-257-5430
Practice Address - Street 1:3129 N SAN FERNANDO RD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065-1412
Practice Address - Country:US
Practice Address - Phone:323-257-7744
Practice Address - Fax:323-257-5430
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53918122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist