WON KOO LEE — NPI 1750498358 (Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) in SAND CITY, CA)

CMS-1500 Box 24J / 33a • NPI

1750498358

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

122300000X (CMS C5)

Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)

Box 32 Service Location & ZIP+4

2030 CALIFORNIA AVE, SUITE A, SAND CITY, CA, 93955-3150

✓ 9-Digit EDI 837 ZIP+4 (93955-3150)

Practice Phone & Referral Fax

(831) 393-1600

Fax: (831) 393-2600

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1750498358 (WON KOO LEE) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1750498358` (NPI-1 Individual Practitioner)
Provider / Legal Name	WON KOO LEE
Plain-English Specialty	Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) NUCC Code: `122300000X` (Dentist)
Certifying / Licensing Body	American Dental Association (ADA) / State Board of Dental Examiners
Practice Location Address	2030 CALIFORNIA AVE, SUITE A, SAND CITY, CA, 93955-3150
Practice Telephone / Fax	Tel: (831) 393-1600 \| Fax: (831) 393-2600
Administrative Mailing Address	2030 CALIFORNIA AVE, SAND CITY, CA, 93955-3150
Enumeration & Last Sync	Enumerated: 2006-08-23 \| CMS Record Updated: 2007-07-08

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

2030 CALIFORNIA AVE, SUITE A, SAND CITY, CA, 93955-3150

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Plain-English Taxonomy & CMS Crosswalk (122300000X)

What Does Taxonomy Code 122300000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 122300000X translates to:
"Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)"

CMS-1500 Medicare Specialty Crosswalk: CMS Code C5 (Dentist)
Certifying / Accrediting Authority: American Dental Association (ADA) / State Board of Dental Examiners
Clinical Scope: Routine 6-month dental checkups, toothache, dental abscess, bleeding gums (periodontitis), or wisdom tooth extraction.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (WON KOO LEE)

Typical CPT / Diagnostic Procedures:

Comprehensive Oral Evaluation, Digital Dental Radiographs & Prophylaxis
Restorative Composite Fillings, Crowns, Endodontic Root Canal & Extractions

Common Therapeutic Classes:

Amoxicillin, Metronidazole & Clindamycin (Odontogenic Infections)
Chlorhexidine Gluconate 0.12% Oral Rinse & High-Fluoride Varnish

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`122300000X` — Dentist Plain English: Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)	State: CA \| License: `34367` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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WON KOO LEE (NPI #1750498358)