Provider Demographics
NPI:1265088512
Name:LEE, JONATHAN CHUNHAN (DDS)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:CHUNHAN
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:MR
Other - First Name:CHUN-HAN
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:12450 SW PIONEER LN
Mailing Address - Street 2:STE B
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008
Mailing Address - Country:US
Mailing Address - Phone:503-590-8883
Mailing Address - Fax:503-590-0955
Practice Address - Street 1:12450 SW PIONEER LN
Practice Address - Street 2:STE B
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008
Practice Address - Country:US
Practice Address - Phone:503-590-8883
Practice Address - Fax:503-590-0955
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60969366122300000X
ORD11239122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist