Provider Demographics
NPI:1659778173
Name:LEE, KYE WON (DDS)
Entity Type:Individual
Prefix:DR
First Name:KYE
Middle Name:WON
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 1:7159 E HAMPDEN AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-3013
Mailing Address - Country:US
Mailing Address - Phone:303-337-5385
Mailing Address - Fax:303-337-1215
Practice Address - Street 1:7159 E HAMPDEN AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-3013
Practice Address - Country:US
Practice Address - Phone:303-337-5385
Practice Address - Fax:303-337-1215
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-26
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1057111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO95956263Medicaid