| Jae Yong Lee Dental Corp | |
|
4924 Carmel Rd La Canada CA 91011-2711 | |
| (213) 210-3291 | |
| Not Available |
| Full Name | Jae Yong Lee Dental Corp |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 4924 Carmel Rd, La Canada, California |
| Authorized Official Name and Position | Jae Yong Lee (PRESIDENT) |
| Authorized Official Contact | 2132103291 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jae Yong Lee Dental Corp 4924 Carmel Rd La Canada CA 91011-2711 Ph: (213) 210-3291 | Jae Yong Lee Dental Corp 4924 Carmel Rd La Canada CA 91011-2711 Ph: (213) 210-3291 |
| NPI Number | 1053743880 |
|---|---|
| Provider Enumeration Date | 08/02/2013 |
| Last Update Date | 08/02/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053743880 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 47932 (California) | Primary |
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