Provider Demographics
NPI:1508979980
Name:LEE, JOSEPHINE KO (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPHINE
Middle Name:KO
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 1:728 S 320TH ST
Mailing Address - Street 2:STE E
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5255
Mailing Address - Country:US
Mailing Address - Phone:253-941-6365
Mailing Address - Fax:253-941-9166
Practice Address - Street 1:728 S 320TH ST
Practice Address - Street 2:STE E
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5255
Practice Address - Country:US
Practice Address - Phone:253-941-6365
Practice Address - Fax:253-941-9166
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA69251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice