Provider Demographics
NPI:1336125442
Name:LEE, KWANG MYUNG SIMON (DMD)
Entity Type:Individual
Prefix:DR
First Name:KWANG MYUNG
Middle Name:SIMON
Last Name:LEE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 HOBRON LN
Mailing Address - Street 2:#3402
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-1226
Mailing Address - Country:US
Mailing Address - Phone:808-386-0858
Mailing Address - Fax:
Practice Address - Street 1:725 KAPIOLANI BLVD
Practice Address - Street 2:SUITE C-305
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-6012
Practice Address - Country:US
Practice Address - Phone:808-593-0078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA533411223G0001X
PADS030250L1223G0001X
HIDT-22751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice