Provider Demographics
NPI:1841477882
Name:LEE, DONGWOO (DDS)
Entity type:Individual
Prefix:MR
First Name:DONGWOO
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24205 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6504
Mailing Address - Country:US
Mailing Address - Phone:310-375-5101
Mailing Address - Fax:310-375-5646
Practice Address - Street 1:24205 HAWTHORNE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6504
Practice Address - Country:US
Practice Address - Phone:310-375-5101
Practice Address - Fax:310-375-5646
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA520771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice