Provider Demographics
NPI:1053565564
Name:KYU LEE DMD,INC.
Entity type:Organization
Organization Name:KYU LEE DMD,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KYU
Authorized Official - Middle Name:HOON
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:949-369-7200
Mailing Address - Street 1:810 AVENIDA PICO
Mailing Address - Street 2:SUITE W
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-5624
Mailing Address - Country:US
Mailing Address - Phone:949-369-7200
Mailing Address - Fax:
Practice Address - Street 1:810 AVENIDA PICO
Practice Address - Street 2:SUITE W
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-5624
Practice Address - Country:US
Practice Address - Phone:949-369-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50772261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental