Provider Demographics
NPI:1801002662
Name:LEE, CHANG HYOK (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHANG
Middle Name:HYOK
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 1:18305 NW WEST UNION RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-2173
Mailing Address - Country:US
Mailing Address - Phone:503-645-4800
Mailing Address - Fax:503-629-8870
Practice Address - Street 1:18305 NW WEST UNION RD
Practice Address - Street 2:SUITE A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-2173
Practice Address - Country:US
Practice Address - Phone:503-645-4800
Practice Address - Fax:503-629-8870
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD7310122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist