Provider Demographics
NPI:1588808117
Name:LEE, DANIEL DONGKYU (DMD)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:DONGKYU
Last Name:LEE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 UNION ST STE 303
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901-1326
Mailing Address - Country:US
Mailing Address - Phone:781-592-4438
Mailing Address - Fax:781-593-1930
Practice Address - Street 1:140 UNION STREET
Practice Address - Street 2:SUITE 303
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1326
Practice Address - Country:US
Practice Address - Phone:781-592-4438
Practice Address - Fax:781-593-1930
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18550491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice