Provider Demographics
NPI:1093933418
Name:LEE, JOHN CHUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHUNG
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 1:2180 STORY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-1608
Mailing Address - Country:US
Mailing Address - Phone:408-923-5297
Mailing Address - Fax:408-251-6077
Practice Address - Street 1:2180 STORY RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-1608
Practice Address - Country:US
Practice Address - Phone:408-923-5297
Practice Address - Fax:408-251-6077
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA418481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice