| Kim & Lee A Dental Corporation | |
|
1686 W Katella Ave Anaheim CA 92802-3015 | |
| (657) 655-4321 | |
| Not Available |
| Full Name | Kim & Lee A Dental Corporation |
|---|---|
| Speciality | Dentist |
| Location | 1686 W Katella Ave, Anaheim, California |
| Authorized Official Name and Position | Linda Mee Young Lee (CEO) |
| Authorized Official Contact | 5033608886 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kim & Lee A Dental Corporation 2046 Arts Ave Brea CA 92821-6161 Ph: (503) 360-8886 | Kim & Lee A Dental Corporation 1686 W Katella Ave Anaheim CA 92802-3015 Ph: (657) 655-4321 |
| NPI Number | 1588288591 |
|---|---|
| Provider Enumeration Date | 06/04/2020 |
| Last Update Date | 11/30/2021 |
| Medicare PECOS PAC ID | 2466843594 |
|---|---|
| Medicare Enrollment ID | O20211229000667 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588288591 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
| Provider Name | Daeuk D Kim |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1356827737 PECOS PAC ID: 8729313242 Enrollment ID: I20190703003063 |
| Provider Name | Linda Mee-young Lee |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1790214484 PECOS PAC ID: 0143610865 Enrollment ID: I20211220000818 |
| Provider Name | Sae Chan Lee |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1700245248 PECOS PAC ID: 8325439748 Enrollment ID: I20211220000902 |
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