Provider Demographics
NPI:1942224118
Name:LEE, JULIA HP (DDS)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:HP
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:742 E COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2105
Mailing Address - Country:US
Mailing Address - Phone:626-405-0707
Mailing Address - Fax:626-795-2731
Practice Address - Street 1:742 E COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2105
Practice Address - Country:US
Practice Address - Phone:626-405-0707
Practice Address - Fax:626-795-2731
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA423521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD42352Medicaid