Provider Demographics
NPI:1649514662
Name:DR. JEE S. LEE, D.D.S., INC
Entity type:Organization
Organization Name:DR. JEE S. LEE, D.D.S., INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEE
Authorized Official - Middle Name:SUNG
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-743-3067
Mailing Address - Street 1:4330 BARRANCA PKWY STE 230
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4756
Mailing Address - Country:US
Mailing Address - Phone:949-786-1234
Mailing Address - Fax:949-786-1515
Practice Address - Street 1:4330 BARRANCA PKWY STE 230
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4756
Practice Address - Country:US
Practice Address - Phone:949-786-1234
Practice Address - Fax:949-786-1515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47387305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization