Provider Demographics
NPI:1356674725
Name:LEE, GRACE HEEKYONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:HEEKYONG
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:GRACE
Other - Middle Name:HEEKYONG
Other - Last Name:KANG-LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:7841 COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-2422
Mailing Address - Country:US
Mailing Address - Phone:714-739-7173
Mailing Address - Fax:714-739-7174
Practice Address - Street 1:7841 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-2422
Practice Address - Country:US
Practice Address - Phone:714-739-7173
Practice Address - Fax:714-739-7174
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58462122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist