Provider Demographics
NPI:1386864197
Name:YOON SUK LEE
Entity Type:Organization
Organization Name:YOON SUK LEE
Other - Org Name:IVY DENTAL EVERETT PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YOON
Authorized Official - Middle Name:SUK
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-252-9713
Mailing Address - Street 1:2722 COLBY AVE STE 508
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-3533
Mailing Address - Country:US
Mailing Address - Phone:425-252-9713
Mailing Address - Fax:425-339-6099
Practice Address - Street 1:2722 COLBY AVE STE 508
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3533
Practice Address - Country:US
Practice Address - Phone:425-252-9713
Practice Address - Fax:425-339-6099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000094911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty