Provider Demographics
NPI:1740530849
Name:LEE, STEPHANIE PUI NING (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:PUI NING
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S EL MOLINO AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2985
Mailing Address - Country:US
Mailing Address - Phone:626-795-0221
Mailing Address - Fax:626-795-3813
Practice Address - Street 1:200 S EL MOLINO AVE STE 6
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2985
Practice Address - Country:US
Practice Address - Phone:626-795-0221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-16
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA621711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program