Provider Demographics
NPI:1457763716
Name:LUKE B. LEE, DMD INC.
Entity Type:Organization
Organization Name:LUKE B. LEE, DMD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SEH
Authorized Official - Middle Name:YOUNG
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-210-8506
Mailing Address - Street 1:15632 S NORMANDIE AVE
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-4016
Mailing Address - Country:US
Mailing Address - Phone:310-532-5232
Mailing Address - Fax:310-532-6908
Practice Address - Street 1:15632 S NORMANDIE AVE
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4016
Practice Address - Country:US
Practice Address - Phone:310-532-5232
Practice Address - Fax:310-532-6908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA552511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty