Provider Demographics
NPI:1215660311
Name:LEE, ANDREW SANGHWUI (DMD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:SANGHWUI
Last Name:LEE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 CITRUS AVE APT 2302
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-6185
Mailing Address - Country:US
Mailing Address - Phone:714-722-1212
Mailing Address - Fax:
Practice Address - Street 1:16098 KAMANA RD # 101
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-1335
Practice Address - Country:US
Practice Address - Phone:760-242-2620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107545122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist