Provider Demographics
NPI:1588835789
Name:LEE, KYUNG JOO (DMD)
Entity Type:Individual
Prefix:DR
First Name:KYUNG
Middle Name:JOO
Last Name:LEE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12734 TORREY BLUFF DR APT 21
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-4295
Mailing Address - Country:US
Mailing Address - Phone:858-750-8329
Mailing Address - Fax:
Practice Address - Street 1:12734 TORREY BLUFF DR APT 21
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-4295
Practice Address - Country:US
Practice Address - Phone:858-750-8329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56227122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist