| NPI | 1609277433 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ETHAN CHUNG AN LEE Dds/President 323-726-3204 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2014-09-11 |
| Last Update Date | 2015-02-26 |