Provider Demographics
NPI:1245433770
Name:LEE, YOUNG JOO (DDS)
Entity type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:JOO
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 1:4925 E 5TH ST STE 111
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2280
Mailing Address - Country:US
Mailing Address - Phone:520-881-8151
Mailing Address - Fax:
Practice Address - Street 1:4925 E 5TH ST STE 111
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2280
Practice Address - Country:US
Practice Address - Phone:520-881-8151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6808122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist