Provider Demographics
NPI:1124171400
Name:LEE, ALLEN HSIU-JEN (DDS)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:HSIU-JEN
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 1:508 W VALLEY BLVD
Mailing Address - Street 2:STE 1
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3791
Mailing Address - Country:US
Mailing Address - Phone:626-289-8809
Mailing Address - Fax:626-795-7778
Practice Address - Street 1:508 W VALLEY BLVD
Practice Address - Street 2:STE 1
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3791
Practice Address - Country:US
Practice Address - Phone:626-289-8809
Practice Address - Fax:626-795-7778
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice