Provider Demographics
NPI:1407821994
Name:LEE, JENNY MYUNGWON (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:MYUNGWON
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601
Mailing Address - Country:US
Mailing Address - Phone:541-884-8668
Mailing Address - Fax:541-885-4854
Practice Address - Street 1:808 MAIN ST.
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601
Practice Address - Country:US
Practice Address - Phone:541-884-8668
Practice Address - Fax:541-885-4854
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-20
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD67521223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics