Provider Demographics
NPI:1184760373
Name:LEE, RUY TSUN (DDS)
Entity type:Individual
Prefix:DR
First Name:RUY
Middle Name:TSUN
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 EAST LAS TUNAS DRIVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1615
Mailing Address - Country:US
Mailing Address - Phone:626-287-5988
Mailing Address - Fax:
Practice Address - Street 1:1008 EAST LAS TUNAS DRIVE
Practice Address - Street 2:SUITE D
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1615
Practice Address - Country:US
Practice Address - Phone:626-287-5988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31059122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD31059OtherDENTI-CAL RENDERPROVIDER
CAG94163-01OtherDENTI-CAL BILLINGPROVIDER