Provider Demographics
NPI:1356424469
Name:CHIHYUNGLEE,DDS,INC.
Entity type:Organization
Organization Name:CHIHYUNGLEE,DDS,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:CHIHYUNG
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-396-5059
Mailing Address - Street 1:2125 S BREA CANYON RD
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-4019
Mailing Address - Country:US
Mailing Address - Phone:909-396-5059
Mailing Address - Fax:909-396-1929
Practice Address - Street 1:2125 S BREA CANYON RD
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-4019
Practice Address - Country:US
Practice Address - Phone:909-396-5059
Practice Address - Fax:909-396-1929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA416381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty