Provider Demographics
NPI:1942926068
Name:LEE, KWANG-LIM (DDS)
Entity Type:Individual
Prefix:DR
First Name:KWANG-LIM
Middle Name:
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 1:5250 N KNOXVILLE AVE APT 117
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-5024
Mailing Address - Country:US
Mailing Address - Phone:917-349-6012
Mailing Address - Fax:
Practice Address - Street 1:502 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:EAST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61611-2068
Practice Address - Country:US
Practice Address - Phone:309-606-5008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.033979122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist