Provider Demographics
NPI:1588078661
Name:LEE, JULIA (DDS)
Entity type:Individual
Prefix:DR
First Name:JULIA
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 1:10715 S PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90303-2113
Mailing Address - Country:US
Mailing Address - Phone:310-419-6463
Mailing Address - Fax:
Practice Address - Street 1:10715 S PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90303-2113
Practice Address - Country:US
Practice Address - Phone:310-419-6463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014158541223G0001X
PADS0408631223G0001X
DCDEN10017771223G0001X
NY0573291223G0001X
CADDS105416122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice