Provider Demographics
NPI:1326259995
Name:LEE, JONGWOOK (DDS)
Entity Type:Individual
Prefix:
First Name:JONGWOOK
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 1:3226 SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-2719
Mailing Address - Country:US
Mailing Address - Phone:310-530-2875
Mailing Address - Fax:310-891-2828
Practice Address - Street 1:3226 SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-2719
Practice Address - Country:US
Practice Address - Phone:310-530-2875
Practice Address - Fax:310-891-2828
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53714122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist