Provider Demographics
NPI:1568246627
Name:LEE, HYO JUNG (DDS)
Entity Type:Individual
Prefix:
First Name:HYO JUNG
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 1:1404 N BEN MADDOX WAY
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93292-2246
Mailing Address - Country:US
Mailing Address - Phone:559-741-9000
Mailing Address - Fax:
Practice Address - Street 1:1404 N BEN MADDOX WAY
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93292-2246
Practice Address - Country:US
Practice Address - Phone:559-741-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109093122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist