Provider Demographics
NPI:1548463672
Name:LEE, SOOJI HONG (DDS)
Entity type:Individual
Prefix:DR
First Name:SOOJI
Middle Name:HONG
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6225 VILLA LINDA CT
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-4721
Mailing Address - Country:US
Mailing Address - Phone:818-279-1634
Mailing Address - Fax:
Practice Address - Street 1:6225 VILLA LINDA CT
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-4721
Practice Address - Country:US
Practice Address - Phone:818-279-1634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA546191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice