Individual provider Active NPI

Kenneth K. Lee, D.D.S.

  • General Practice Dentistry
  • Chino Hills, CA
National Provider Identifier
1912929548
Registry record updated May 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DDS29734 Issued in CA
Practice address
1675 Rancho Hills Dr
Chino Hills, CA 91709-4745
Phone
(845) 893-8507
NPI assigned
Jul 24, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 24, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DDS29734 CA Primary

Addresses

Primary practice location

1675 Rancho Hills Dr
Chino Hills, CA 91709-4745

Mailing address

1675 Rancho Hills Dr
Chino Hills, CA 91709-4745
Phone (845) 893-8507

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160309000754 NY Order and Referring Only - DentistPractitioner - Dentist 1951607415

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DDS29734CAMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653350400000",
    "number": "1912929548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1675 RANCHO HILLS DR",
            "city": "CHINO HILLS",
            "state": "CA",
            "postal_code": "917094745",
            "telephone_number": "845-893-8507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1675 RANCHO HILLS DR",
            "city": "CHINO HILLS",
            "state": "CA",
            "postal_code": "917094745",
            "telephone_number": "845-893-8507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "KENNETH",
        "middle_name": "K.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-24",
        "last_updated": "2022-05-24",
        "certification_date": "2022-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "DDS29734",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chino Hills, CA

Sources for this page

Verify at the official NPI Registry.