Provider Demographics
NPI:1588247175
Name:MIYAUCHI, LEE (DDS)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:MIYAUCHI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7051 ANGORA ST
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-8332
Mailing Address - Country:US
Mailing Address - Phone:323-631-7797
Mailing Address - Fax:
Practice Address - Street 1:654 W 4TH ST # A
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410-3216
Practice Address - Country:US
Practice Address - Phone:909-693-4103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1052191223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry