Provider Demographics
NPI:1851418255
Name:LEE, SAMUEL SOONHO (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:SOONHO
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-4625
Mailing Address - Country:US
Mailing Address - Phone:714-718-3446
Mailing Address - Fax:888-391-8014
Practice Address - Street 1:6727 FLANDERS DR STE 220
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2926
Practice Address - Country:US
Practice Address - Phone:714-718-3446
Practice Address - Fax:888-553-4912
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1855469122300000X
CA513531223S0112X, 122300000X
NY054368-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist