Provider Demographics
NPI:1093208514
Name:LEE, SUNGGYU (DMD)
Entity Type:Individual
Prefix:
First Name:SUNGGYU
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12300 FARINACCI CT APT 3
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-5966
Mailing Address - Country:US
Mailing Address - Phone:330-554-8056
Mailing Address - Fax:
Practice Address - Street 1:15207 PEARL RD
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-5020
Practice Address - Country:US
Practice Address - Phone:440-572-4840
Practice Address - Fax:440-572-3814
Is Sole Proprietor?:No
Enumeration Date:2018-06-09
Last Update Date:2018-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0254801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice