Provider Demographics
NPI:1831335579
Name:SUSAN THUYMINH LEE D.D.S. INC
Entity type:Organization
Organization Name:SUSAN THUYMINH LEE D.D.S. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:THUYMINH
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-270-7723
Mailing Address - Street 1:2726 ABORN RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-1276
Mailing Address - Country:US
Mailing Address - Phone:408-270-7723
Mailing Address - Fax:408-223-8717
Practice Address - Street 1:2726 ABORN RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-1276
Practice Address - Country:US
Practice Address - Phone:408-270-7723
Practice Address - Fax:408-223-8717
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPA DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-31
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47750305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization