Provider Demographics
NPI:1134321516
Name:LEE, KEVIN KWONKI (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:KWONKI
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:KEVIN
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:22342 AVENIDA EMPRESA STE 285
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-2162
Mailing Address - Country:US
Mailing Address - Phone:949-589-1150
Mailing Address - Fax:
Practice Address - Street 1:22342 AVENIDA EMPRESA STE 285
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-2162
Practice Address - Country:US
Practice Address - Phone:949-589-1150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA511011223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics