Provider Demographics
NPI:1417076787
Name:LEE, FONG-CHU (DDS)
Entity type:Individual
Prefix:DR
First Name:FONG-CHU
Middle Name:
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 1:730 E EL CAMINO REAL STE C
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-2971
Mailing Address - Country:US
Mailing Address - Phone:408-530-8881
Mailing Address - Fax:408-530-8884
Practice Address - Street 1:730 E EL CAMINO REAL STE C
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-2971
Practice Address - Country:US
Practice Address - Phone:408-530-8881
Practice Address - Fax:408-530-8884
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA396741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice