Provider Demographics
NPI:1780712430
Name:LEE, SUNGKI (DMD)
Entity type:Individual
Prefix:DR
First Name:SUNGKI
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 PARK AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3063
Mailing Address - Country:US
Mailing Address - Phone:732-452-0100
Mailing Address - Fax:732-452-0178
Practice Address - Street 1:3900 PARK AVE STE 105
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3063
Practice Address - Country:US
Practice Address - Phone:732-452-0100
Practice Address - Fax:732-452-0178
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI194401223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry