Provider Demographics
NPI:1164200754
Name:LEE, SUNGWHAN (DDS)
Entity Type:Individual
Prefix:
First Name:SUNGWHAN
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 1:5887 HADDLER CT
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-2245
Mailing Address - Country:US
Mailing Address - Phone:614-395-9678
Mailing Address - Fax:
Practice Address - Street 1:98-150 KAONOHI ST STE C201
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-5022
Practice Address - Country:US
Practice Address - Phone:808-748-4970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-3132-01223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice