Provider Demographics
NPI:1649425935
Name:LEE, OK R (DN 00000474)
Entity type:Individual
Prefix:MRS
First Name:OK
Middle Name:R
Last Name:LEE
Suffix:
Gender:F
Credentials:DN 00000474
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4045 220TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98053-2801
Mailing Address - Country:US
Mailing Address - Phone:425-836-8504
Mailing Address - Fax:
Practice Address - Street 1:11545 15TH AVE NE
Practice Address - Street 2:#201
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-6358
Practice Address - Country:US
Practice Address - Phone:425-443-2807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN 00000474122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist