Provider Demographics
NPI:1285774679
Name:LEE, DOUGLAS GU (DDS)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:GU
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 1:9432 GARDEN GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1453
Mailing Address - Country:US
Mailing Address - Phone:714-537-5350
Mailing Address - Fax:714-537-6567
Practice Address - Street 1:9432 GARDEN GROVE BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-1453
Practice Address - Country:US
Practice Address - Phone:714-537-5350
Practice Address - Fax:714-537-6567
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB33320122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist