Provider Demographics
NPI:1104953975
Name:LEE, LILY HEUNG (DDS)
Entity type:Individual
Prefix:DR
First Name:LILY
Middle Name:HEUNG
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9957 W TARON DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-8160
Mailing Address - Country:US
Mailing Address - Phone:916-686-2332
Mailing Address - Fax:
Practice Address - Street 1:219 W CALAVERAS BLVD
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-5203
Practice Address - Country:US
Practice Address - Phone:408-262-2321
Practice Address - Fax:408-262-2138
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA459021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice