Provider Demographics
NPI:1841349495
Name:LEE, BRIAN Y (DMD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:Y
Last Name:LEE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:BRIAN
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:21605 HAWTHORNE BLVD, PAVILLION C, STE 120
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503
Mailing Address - Country:US
Mailing Address - Phone:310-540-4114
Mailing Address - Fax:310-316-9487
Practice Address - Street 1:21605 HAWTHORNE BLVD, PAVILLION C, STE 120
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503
Practice Address - Country:US
Practice Address - Phone:310-540-4114
Practice Address - Fax:310-316-9487
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA217221223P0700X
CA1014171223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics