1649500166 NPI number — DAVID BO LEE, DDS, INC.

Table of content: (NPI 1649500166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649500166 NPI number — DAVID BO LEE, DDS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID BO LEE, DDS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649500166
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
942 W ORANGETHORPE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FULLERTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92832-2827
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-525-1130
Provider Business Mailing Address Fax Number:
714-525-1415

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
942 W ORANGETHORPE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FULLERTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92832-2827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-525-1130
Provider Business Practice Location Address Fax Number:
714-525-1415
Provider Enumeration Date:
01/06/2010

Additional Information

Authorized Official

Authorized Official Last Name:
LEE
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
BO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
714-525-1130

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: B46196-01 . This is a "DELTA DENTAL HEALTHY FAMILY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: G93421-01 . This is a "MEDI-CAL PROVIDER #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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