Organization
MENIFEE ENDODONTICS
Active
Parent organization
CUCAMONGA PEAK ENDODONTICS
Organization subpart
Yes
Provider details
NPI number
Legal business name
CUCAMONGA PEAK ENDODONTICS
Authorized official
JAEHOON LEE DMD (ENDODONTIST)
(909) 945-5262
Entity
Organization
Contact information
Practice address
27174 NEWPORT RD STE 1, MENIFEE, CA 92584-7384
(951) 723-8801
Mailing address
27174 NEWPORT RD STE 1, MENIFEE, CA 92584-7384
(909) 945-5262
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
54854
CA
1223E0200X
Endodontics
Primary
63274
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1376928481
ENDODONTIST
CA
Enumeration date
02/09/2017
Last updated
02/09/2017
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