Provider Demographics
NPI:1467509646
Name:LEE, LUKE BYUNG CHUL (DDS)
Entity type:Individual
Prefix:DR
First Name:LUKE
Middle Name:BYUNG CHUL
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:BYUNG
Other - Middle Name:CHUL
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3400 LOMA VISTA RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3033
Mailing Address - Country:US
Mailing Address - Phone:805-639-9205
Mailing Address - Fax:805-639-9230
Practice Address - Street 1:3400 LOMA VISTA RD
Practice Address - Street 2:SUITE 11
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3033
Practice Address - Country:US
Practice Address - Phone:805-639-9205
Practice Address - Fax:805-639-9230
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA552511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice