Provider Demographics
NPI:1619476470
Name:LEE, JUNG YEOL (DMD)
Entity Type:Individual
Prefix:
First Name:JUNG
Middle Name:YEOL
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 1:10431 LEMON AVE STE K
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-3766
Mailing Address - Country:US
Mailing Address - Phone:909-476-8303
Mailing Address - Fax:
Practice Address - Street 1:10431 LEMON AVE STE K
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91737-3766
Practice Address - Country:US
Practice Address - Phone:909-476-8303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-07
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1020791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice