Provider Demographics
NPI:1558410837
Name:LEE, MYUNG JEAN
Entity Type:Individual
Prefix:DR
First Name:MYUNG
Middle Name:JEAN
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:MYUNG
Other - Middle Name:JEAN
Other - Last Name:KAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5665 MONCLOVA ROAD
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-1835
Mailing Address - Country:US
Mailing Address - Phone:419-893-3376
Mailing Address - Fax:419-893-0575
Practice Address - Street 1:5665 MONCLOVA ROAD
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1835
Practice Address - Country:US
Practice Address - Phone:419-893-3376
Practice Address - Fax:419-893-0575
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300209991223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHBCMH2373300OtherBUREAU OF HANDICAPS