Individual
DR. JINAH LEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
4731 E SOUTHERN AVE, PHOENIX, AZ 85042-4150
(602) 470-9191
(602) 470-9731
Mailing address
4731 E SOUTHERN AVE, PHOENIX, AZ 85042-4150
(602) 470-9191
(602) 470-9731
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5870
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0413620
BLUECROSS BLUESHIELD
—
01
—
1587028
UNITED CONCORDIA
—
01
—
5870
STATE DENTAL LICENSE
AZ
01
—
854829
AHCCCS
AZ
01
—
F14635
PHOENIX HEALTH PLAN
AZ
Enumeration date
12/12/2006
Last updated
07/08/2007
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