Provider Demographics
NPI:1407045784
Name:LEE, KELLY YUN-KYUNG (DMD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:YUN-KYUNG
Last Name:LEE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 WENDY LN
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-4814
Mailing Address - Country:US
Mailing Address - Phone:917-488-5903
Mailing Address - Fax:
Practice Address - Street 1:241 W 23RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-2320
Practice Address - Country:US
Practice Address - Phone:212-691-2112
Practice Address - Fax:212-691-2115
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0493791223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics