Provider Demographics
NPI:1811017668
Name:LEE, SUK KI KATHLEEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUK KI
Middle Name:KATHLEEN
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 SE TECH CENTER DR
Mailing Address - Street 2:SUITE 195
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-5504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1001 SW 5TH AVE
Practice Address - Street 2:SUITE 222
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-1147
Practice Address - Country:US
Practice Address - Phone:503-222-5355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD74211223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics