Dr Samuel Lee Dental Corp

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

51353 Issued in CA

Legal business name

DR SAMUEL LEE DENTAL CORP

Doing business as

International Academy of Dental Implant

Practice address

6727 Flanders Dr Ste 220
San Diego, CA 92121-2926

Phone

(858) 229-9869

NPI assigned

Jul 7, 2016

Last updated

Jul 7, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Samuel S Lee, DDS DMSCNPI 1851418255

Title

President

Phone

(714) 718-3446

Specialties & licenses 2

Addresses

Other names 1

• International Academy of Dental Implant Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Samuel Soonho Lee, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • San Diego, CA
  • NPI 1851418255
  NPD (past) Authorized official

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

{
    "created_epoch": "1467849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467849600000",
    "number": "1528410123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6727 FLANDERS DRIVE #220",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92121",
            "telephone_number": "858-229-9869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6727 FLANDERS DR STE 220",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921212926",
            "telephone_number": "858-229-9869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR SAMUEL LEE DENTAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-07",
        "last_updated": "2016-07-07",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-718-3446",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS DMSC"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "58462",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "51353",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "International Academy of Dental Implant",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Periodontics in San Diego, CA
• Providers in San Diego, CA by specialty
• Periodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2016; 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.