Provider Demographics
NPI:1750454609
Name:LEE, DUK-SUN (DDS)
Entity Type:Individual
Prefix:
First Name:DUK-SUN
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 1:81106 US HIGHWAY 111 STE C
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-6600
Mailing Address - Country:US
Mailing Address - Phone:760-775-7779
Mailing Address - Fax:760-775-7734
Practice Address - Street 1:81106 US HIGHWAY 111 STE C
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-6600
Practice Address - Country:US
Practice Address - Phone:760-775-7779
Practice Address - Fax:760-775-7734
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA491331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice