Provider Demographics
NPI:1104979228
Name:LEE, YOUNG WOO (DDS)
Entity type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:WOO
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30821 14TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-4700
Mailing Address - Country:US
Mailing Address - Phone:253-839-0660
Mailing Address - Fax:253-839-6336
Practice Address - Street 1:30821 14TH AVE S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-4700
Practice Address - Country:US
Practice Address - Phone:253-839-0660
Practice Address - Fax:253-839-6336
Is Sole Proprietor?:No
Enumeration Date:2007-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA82531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice