Provider Demographics
NPI:1861703639
Name:LEE, CHOONG HYUN (DMD)
Entity type:Individual
Prefix:DR
First Name:CHOONG
Middle Name:HYUN
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 1:341 C STREET
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230
Mailing Address - Country:US
Mailing Address - Phone:360-332-8737
Mailing Address - Fax:360-332-6806
Practice Address - Street 1:341 C STREET
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:WA
Practice Address - Zip Code:98230
Practice Address - Country:US
Practice Address - Phone:360-332-8737
Practice Address - Fax:360-332-6806
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000098691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice