Provider Demographics
NPI:1063008233
Name:LEE, WOOJIN (DDS)
Entity Type:Individual
Prefix:
First Name:WOOJIN
Middle Name:
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 1:3060 W OLYMPIC BLVD APT 514
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-3839
Mailing Address - Country:US
Mailing Address - Phone:847-971-1920
Mailing Address - Fax:
Practice Address - Street 1:3060 W OLYMPIC BLVD APT 514
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-3839
Practice Address - Country:US
Practice Address - Phone:847-971-1920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1058731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice