Provider Demographics
NPI:1922293471
Name:LEE, JIN U (DPD)
Entity Type:Individual
Prefix:DR
First Name:JIN
Middle Name:U
Last Name:LEE
Suffix:
Gender:M
Credentials:DPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18009 HWY 99 STE C
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-4499
Mailing Address - Country:US
Mailing Address - Phone:425-672-8494
Mailing Address - Fax:
Practice Address - Street 1:18009 HWY 99 STE C
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-4499
Practice Address - Country:US
Practice Address - Phone:425-672-8494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN00000448122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5053442Medicaid