Provider Demographics
NPI:1750276168
Name:LEE, JI WON (DMD)
Entity type:Individual
Prefix:DR
First Name:JI WON
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22655 CHAGRIN BLVD UNIT 103
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5315
Mailing Address - Country:US
Mailing Address - Phone:808-219-5073
Mailing Address - Fax:
Practice Address - Street 1:22655 CHAGRIN BLVD UNIT 103
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5315
Practice Address - Country:US
Practice Address - Phone:808-219-5073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30028059122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist