Provider Demographics
NPI:1922538347
Name:LEE, KI HOON (DDS)
Entity Type:Individual
Prefix:
First Name:KI
Middle Name:HOON
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:KI
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1385 RIDGE RD APT 369
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-4264
Mailing Address - Country:US
Mailing Address - Phone:903-806-5883
Mailing Address - Fax:
Practice Address - Street 1:422 OAK AVE
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-4130
Practice Address - Country:US
Practice Address - Phone:903-885-8906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2017-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX330351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice