Provider Demographics
NPI:1710186630
Name:LEE, KWANGHO (DDS)
Entity Type:Individual
Prefix:DR
First Name:KWANGHO
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:KENNY
Other - Middle Name:KH
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:4215 198TH ST SW STE 205
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6738
Mailing Address - Country:US
Mailing Address - Phone:425-775-1800
Mailing Address - Fax:
Practice Address - Street 1:4215 198TH ST SW STE 205
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6738
Practice Address - Country:US
Practice Address - Phone:425-775-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000100621223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics