Provider Demographics
NPI:1538255435
Name:LEE, STEVE SIWOO (DDS)
Entity type:Individual
Prefix:DR
First Name:STEVE
Middle Name:SIWOO
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 1:850 INDIAN HILL BLVD
Mailing Address - Street 2:C/O POMONA DENTAL GROUP
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-5308
Mailing Address - Country:US
Mailing Address - Phone:909-626-3541
Mailing Address - Fax:909-621-9751
Practice Address - Street 1:850 INDIAN HILL BLVD
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-5308
Practice Address - Country:US
Practice Address - Phone:909-626-3541
Practice Address - Fax:909-621-9751
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD32574CA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice