Provider Demographics
NPI:1801903810
Name:LEE, SANGYOON (DDS)
Entity type:Individual
Prefix:DR
First Name:SANGYOON
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:SANG YOON
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:3619 PARK EAST DR STE 312
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4312
Mailing Address - Country:US
Mailing Address - Phone:216-245-7543
Mailing Address - Fax:
Practice Address - Street 1:3619 PARK EAST DR STE 312
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4312
Practice Address - Country:US
Practice Address - Phone:216-245-7543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH218471223P0300X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2541646Medicaid