| Soonki Lee Dds Pc | |
|
3030 W Olympic Blvd Ste 216 Los Angeles CA 90006-6507 | |
| (213) 384-1036 | |
| Not Available |
| Full Name | Soonki Lee Dds Pc |
|---|---|
| Speciality | Dentist |
| Location | 3030 W Olympic Blvd Ste 216, Los Angeles, California |
| Authorized Official Name and Position | Soonki Lee (OWNER) |
| Authorized Official Contact | 2133841036 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Soonki Lee Dds Pc 3030 W Olympic Blvd Ste 216 Los Angeles CA 90006-6507 Ph: (213) 384-1036 | Soonki Lee Dds Pc 3030 W Olympic Blvd Ste 216 Los Angeles CA 90006-6507 Ph: (213) 384-1036 |
| NPI Number | 1033618681 |
|---|---|
| Provider Enumeration Date | 02/09/2018 |
| Last Update Date | 09/13/2018 |
| Medicare PECOS PAC ID | 6204197437 |
|---|---|
| Medicare Enrollment ID | O20180302000550 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033618681 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | DDS62164 (California) | Primary |
| Provider Name | Soonki Lee |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1255688214 PECOS PAC ID: 2466713698 Enrollment ID: I20180302000690 |
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