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Organization
SIMON LEE DENTAL
Active
Organization
SIMON LEE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SIMON HYUN LEE (OWNER)
(707) 994-6000
Entity
Organization
Contact information
Practice address
15130 LAKESHORE DR, CLEARLAKE, CA 95422
(707) 994-6000
(707) 994-7589
Mailing address
15130 LAKESHORE DR, CLEARLAKE, CA 95422
(707) 994-6000
(707) 994-7589
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
37978
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G9342001
MEDICAL
CA
Enumeration date
08/30/2006
Last updated
08/22/2020
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