Provider Demographics
NPI:1912153099
Name:LEE, HA N (DDS)
Entity Type:Individual
Prefix:
First Name:HA
Middle Name:N
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:HA
Other - Middle Name:T
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:24864 MUIRLANDS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-4812
Mailing Address - Country:US
Mailing Address - Phone:949-586-5531
Mailing Address - Fax:
Practice Address - Street 1:24864 MUIRLANDS BLVD
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-4812
Practice Address - Country:US
Practice Address - Phone:949-586-5531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-08
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57458122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist