Organization
SUSAN J. LEE, DMD, MD INC
Active
Other names
Glendora Oral Surgery and Implant Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSAN JEAN LEE MD (PRESIDENT)
(818) 939-4378
Entity
Organization
Contact information
Practice address
175 N PENNSYLVANIA AVE STE 3, GLENDORA, CA 91741-3316
(626) 852-0365
(626) 852-0369
Mailing address
11851 LAURELWOOD DR APT 103, STUDIO CITY, CA 91604-4928
(818) 939-4378
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14457151
CAQH
—
Enumeration date
06/15/2020
Last updated
06/15/2020
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