NPIMap

Organization Active NPI

Wonjoo Lee, DDS, Inc.

  • Dentist
  • Oakland, CA
National Provider Identifier
1508137142
Registry record updated Jan 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
49923 Issued in CA
Legal business name
WONJOO LEE, DDS, INC.
Practice address
3540 Grand Ave
Suite 100
Oakland, CA 94610-2010
Phone
(510) 208-3012
Fax
(510) 208-4524
NPI assigned
Jan 12, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2012

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

Authorized official

Name
Dr. Wonjoo LeeNPI 1194887364
Title
President
Phone
(510) 208-3012

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 49923 CA Primary

Addresses

Primary practice location

3540 Grand Ave
Suite 100
Oakland, CA 94610-2010

Mailing address

3540 Grand Ave
Suite 100
Oakland, CA 94610-2010
Phone (510) 208-3012

Other names 1

  • Grand Lake Dental Doing business as

National Provider Directory

National Provider Directory

Locations

3540 Grand Ave
Ste 100
Oakland, CA 94610
Phone (510) 208-3012

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1326326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326326400000",
    "number": "1508137142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3540 GRAND AVE",
            "address_2": "SUITE 100",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946102010",
            "telephone_number": "510-208-3012",
            "fax_number": "510-208-4524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3540 GRAND AVE",
            "address_2": "SUITE 100",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946102010",
            "telephone_number": "510-208-3012",
            "fax_number": "510-208-4524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WONJOO LEE, DDS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-12",
        "last_updated": "2012-01-12",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "WONJOO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "510-208-3012",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "49923",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grand Lake Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oakland, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2012; 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.