Susan J. Lee, DMD, MD Inc

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

Legal business name

SUSAN J. LEE, DMD, MD INC

Practice address

175 N Pennsylvania Ave Ste 3
Glendora, CA 91741-3316

Phone

(626) 852-0365

Fax

(626) 852-0369

NPI assigned

Jun 15, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Susan Jean Lee, MD

Title

President

Phone

(818) 939-4378

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Glendora Oral Surgery and Implant Center Doing business as

Electronic endpoints 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1592179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592179200000",
    "number": "1235754334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11851 LAURELWOOD DR APT 103",
            "city": "STUDIO CITY",
            "state": "CA",
            "postal_code": "916044928",
            "telephone_number": "818-939-4378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 N PENNSYLVANIA AVE STE 3",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917413316",
            "telephone_number": "626-852-0365",
            "fax_number": "626-852-0369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSAN J. LEE, DMD, MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-15",
        "last_updated": "2020-06-15",
        "certification_date": "2020-06-15",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-939-4378",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "14457151",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Glendora",
            "affiliation": "N",
            "address_1": "175 N Pennsylvania Ave Ste 3",
            "city": "Glendora",
            "state": "CA",
            "country_code": "US",
            "postal_code": "917413316",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Glendora Oral Surgery and Implant Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Oral & Maxillofacial Surgery (D.M.D.) in Glendora, CA
• Providers in Glendora, CA by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.