Provider Demographics
NPI:1033573647
Name:LEE, JUNG AH
Entity Type:Individual
Prefix:MRS
First Name:JUNG AH
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 ASBURY ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-5143
Mailing Address - Country:US
Mailing Address - Phone:213-222-3149
Mailing Address - Fax:
Practice Address - Street 1:5455 RICHMOND AVE
Practice Address - Street 2:APT 2011
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-6780
Practice Address - Country:US
Practice Address - Phone:213-222-3149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-09
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32250122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist