Provider Demographics
NPI:1295777316
Name:LEE, KATHERINE JEEYEON (DMD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:JEEYEON
Last Name:LEE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 BUFORD HWY.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-8215
Mailing Address - Country:US
Mailing Address - Phone:770-205-1212
Mailing Address - Fax:770-205-1211
Practice Address - Street 1:2950 BUFORD HWY.
Practice Address - Street 2:SUITE 200
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-8215
Practice Address - Country:US
Practice Address - Phone:770-205-1212
Practice Address - Fax:770-205-1211
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0512181223G0001X
GADN 0134731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice