Provider Demographics
NPI:1750498358
Name:LEE, WON KOO
Entity Type:Individual
Prefix:
First Name:WON
Middle Name:KOO
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 CALIFORNIA AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAND CITY
Mailing Address - State:CA
Mailing Address - Zip Code:93955-3150
Mailing Address - Country:US
Mailing Address - Phone:831-393-1600
Mailing Address - Fax:831-393-2600
Practice Address - Street 1:2030 CALIFORNIA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SAND CITY
Practice Address - State:CA
Practice Address - Zip Code:93955-3150
Practice Address - Country:US
Practice Address - Phone:831-393-1600
Practice Address - Fax:831-393-2600
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34367122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist