Provider Demographics
NPI:1457599656
Name:LEE, SANGMOO (DDS)
Entity Type:Individual
Prefix:
First Name:SANGMOO
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:SCOTT
Other - Middle Name:SANGMOO
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:3030 W 8TH ST
Mailing Address - Street 2:#305
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-1887
Mailing Address - Country:US
Mailing Address - Phone:213-384-4400
Mailing Address - Fax:
Practice Address - Street 1:3030 W 8TH ST
Practice Address - Street 2:#305
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-1887
Practice Address - Country:US
Practice Address - Phone:213-384-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA540861223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics