Sang Eun Lee Dental Corp

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

55451 Issued in CA

Legal business name

SANG EUN LEE DENTAL CORP

Doing business as

Wellness Dental Care

Practice address

72724 Twentynine Palms Hwy #102
Twentynine Palms, CA 92277

Phone

(760) 367-7645

NPI assigned

Sep 14, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Sang Eun Lee, D.D.S.

Title

C.E.O

Phone

(909) 851-7323

Specialties & licenses 1

Addresses

Other names 1

• Wellness Dental Care Doing business as

Locations

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

{
    "created_epoch": "1473811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473811200000",
    "number": "1659829141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "72724 TWENTYNINE PALMS HWY #102",
            "city": "TWENTYNINE PALMS",
            "state": "CA",
            "postal_code": "92277",
            "telephone_number": "760-367-7645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72724 TWENTYNINE PALMS HWY #102",
            "city": "TWENTYNINE PALMS",
            "state": "CA",
            "postal_code": "92277",
            "telephone_number": "760-367-7645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANG EUN LEE DENTAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-14",
        "last_updated": "2016-09-14",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "SANG",
        "authorized_official_middle_name": "EUN",
        "authorized_official_title_or_position": "C.E.O",
        "authorized_official_telephone_number": "909-851-7323",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "55451",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wellness Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alex Rubang
• Rodney Scott Ruth Jr., IDC
• Gretchen Sachs, MD
• Mary Barbara Saeed
• Tristan Faile Salomon, PT
• Rahulbhai Savalia
• Richard Joseph Scheuerle III, MD
• Fredrik D Schmitz, MPT OCS SCS
• Kenza Schreiber, DDS
• Benjamin Jason Schwartz, PHARM.D.

• General Practice Dentistry in Twentynine Palms, CA
• Providers in Twentynine Palms, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 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.