Provider Demographics
NPI:1508127135
Name:LEE, KYOUNG YUN (DDS)
Entity Type:Individual
Prefix:
First Name:KYOUNG YUN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 E 14TH ST
Mailing Address - Street 2:6E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-3119
Mailing Address - Country:US
Mailing Address - Phone:917-543-9132
Mailing Address - Fax:
Practice Address - Street 1:141 E PERSHING RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-3213
Practice Address - Country:US
Practice Address - Phone:217-877-6559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT010747122300000X
IL019029708122300000X
NJ22DI02568700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist