Provider Demographics
NPI:1962482380
Name:LEE, JOHN KEUN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KEUN
Last Name:LEE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 DONNA DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-2848
Mailing Address - Country:US
Mailing Address - Phone:610-277-8577
Mailing Address - Fax:
Practice Address - Street 1:250 MAKALAPA DR
Practice Address - Street 2:COMPACFLT HEALTH SERVICES (N01HD) ATTN PA COOR
Practice Address - City:PEARL HARBOR
Practice Address - State:HI
Practice Address - Zip Code:96860-3131
Practice Address - Country:US
Practice Address - Phone:808-471-2463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0362291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice