Individual
DONG SUP LEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
446 W CENTRAL AVE, BREA, CA 92821-3004
(804) 928-4695
Mailing address
446 W CENTRAL AVE, BREA, CA 92821-3004
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
108937
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/24/2023
Last updated
07/11/2023
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