Provider Demographics
NPI:1558543736
Name:LEE, KEVIN SEOKKYU (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:SEOKKYU
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BARSTOW RD STE P23
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3501
Mailing Address - Country:US
Mailing Address - Phone:516-466-8744
Mailing Address - Fax:516-829-3650
Practice Address - Street 1:1 BARSTOW RD STE P23
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-3501
Practice Address - Country:US
Practice Address - Phone:516-466-8744
Practice Address - Fax:516-829-3650
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY50-0529681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice