Provider Demographics
NPI:1215369574
Name:LEE, IN KYUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:IN KYUNG
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-6005
Mailing Address - Country:US
Mailing Address - Phone:203-235-4930
Mailing Address - Fax:203-235-4932
Practice Address - Street 1:725 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-6005
Practice Address - Country:US
Practice Address - Phone:203-235-4930
Practice Address - Fax:203-235-4932
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-08
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0110251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice