Provider Demographics
NPI:1265602783
Name:LEE, WEE& BAEK.DDS.INC
Entity type:Organization
Organization Name:LEE, WEE& BAEK.DDS.INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JIN NAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BAEK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-756-0069
Mailing Address - Street 1:61325 29 PALMS HWY STE A
Mailing Address - Street 2:
Mailing Address - City:JOSHUA TREE
Mailing Address - State:CA
Mailing Address - Zip Code:92252-1912
Mailing Address - Country:US
Mailing Address - Phone:760-366-0420
Mailing Address - Fax:760-360-0520
Practice Address - Street 1:61325 29 PALMS HWY STE A
Practice Address - Street 2:
Practice Address - City:JOSHUA TREE
Practice Address - State:CA
Practice Address - Zip Code:92252-1912
Practice Address - Country:US
Practice Address - Phone:760-366-0420
Practice Address - Fax:760-360-0520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54709122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty