Provider Demographics
NPI:1710290887
Name:LEE, SEUNGHYUN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SEUNGHYUN
Middle Name:
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 1:1770 GRAND CONCOURSE APT 2F
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-5526
Mailing Address - Country:US
Mailing Address - Phone:718-901-8110
Mailing Address - Fax:718-901-8121
Practice Address - Street 1:1770 GRAND CONCOURSE APT 2F
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-5526
Practice Address - Country:US
Practice Address - Phone:718-901-8110
Practice Address - Fax:718-901-8121
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT010537122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist