Provider Demographics
NPI:1649565029
Name:LEE, KRISTY EUNLIM (DDS)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:EUNLIM
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 1:1234 19TH ST NW STE 710
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-2441
Mailing Address - Country:US
Mailing Address - Phone:202-783-3450
Mailing Address - Fax:
Practice Address - Street 1:1234 19TH ST NW STE 710
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-2441
Practice Address - Country:US
Practice Address - Phone:202-783-3450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN1001636122300000X
VA0401414236122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist