Provider Demographics
NPI:1386999779
Name:LEE, YVONNE SHUWA (DMD)
Entity type:Individual
Prefix:DR
First Name:YVONNE
Middle Name:SHUWA
Last Name:LEE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 VERDUGO BLVD
Mailing Address - Street 2:SUITE 312
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1477
Mailing Address - Country:US
Mailing Address - Phone:818-790-6721
Mailing Address - Fax:
Practice Address - Street 1:1808 VERDUGO HILLS
Practice Address - Street 2:SUITE 312
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1456
Practice Address - Country:US
Practice Address - Phone:818-790-6721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-21
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA610481223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry