Provider Demographics
NPI:1487059010
Name:KENENTH K. LEE, D.D.S., INC.
Entity type:Organization
Organization Name:KENENTH K. LEE, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SOKVY
Authorized Official - Middle Name:
Authorized Official - Last Name:NGONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-494-5060
Mailing Address - Street 1:4755 E ANAHEIM ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-3123
Mailing Address - Country:US
Mailing Address - Phone:562-494-5060
Mailing Address - Fax:
Practice Address - Street 1:4755 E. ANAHEIM ST.
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804
Practice Address - Country:US
Practice Address - Phone:562-494-5060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENENTH K. LEE, D.D.S., INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40652305R00000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No305R00000XManaged Care OrganizationsPreferred Provider OrganizationGroup - Single Specialty