Provider Demographics
NPI:1578845277
Name:LEE, WOONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:WOONG
Middle Name:
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 1:2100 W COMMONWEALTH AVE APT 237
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-3019
Mailing Address - Country:US
Mailing Address - Phone:915-588-9617
Mailing Address - Fax:
Practice Address - Street 1:20700 AVALON BLVD STE 600
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3701
Practice Address - Country:US
Practice Address - Phone:310-241-6175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX274481223G0001X
CA1012021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice