Provider Demographics
NPI:1548465610
Name:KOO, HEAMO LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:HEAMO
Middle Name:LEE
Last Name:KOO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:STEVE
Other - Middle Name:LEE
Other - Last Name:KOO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:4324 OLEANDER ST
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-5227
Mailing Address - Country:US
Mailing Address - Phone:713-661-9472
Mailing Address - Fax:
Practice Address - Street 1:2450 FONDREN RD STE 320
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-2320
Practice Address - Country:US
Practice Address - Phone:713-783-3116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX198541223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery