Provider Demographics
NPI:1508261264
Name:LEE, JOHN KEUNHEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KEUNHEE
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:MARK
Other - Last Name:AN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3300 E 1ST AVE STE 580
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5818
Mailing Address - Country:US
Mailing Address - Phone:303-321-0055
Mailing Address - Fax:
Practice Address - Street 1:3300 E 1ST AVE STE 580
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5818
Practice Address - Country:US
Practice Address - Phone:303-321-0055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN002039481223G0001X
IN12012235A122300000X
IL019030490122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist