Provider Demographics
NPI:1972835155
Name:LEE, CHULJOO (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHULJOO
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 1:4905 OLD ORCHARD CTR
Mailing Address - Street 2:STE426
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1458
Mailing Address - Country:US
Mailing Address - Phone:847-675-0882
Mailing Address - Fax:847-675-0882
Practice Address - Street 1:4905 OLD ORCHARD CTR
Practice Address - Street 2:STE426
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1458
Practice Address - Country:US
Practice Address - Phone:847-675-0882
Practice Address - Fax:847-675-0882
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190165671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019016567OtherSTATE OF ILLINOIS LICENSED DENTIST