Provider Demographics
NPI:1124427638
Name:LEE, DANIEL JONGCHAN (DMD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JONGCHAN
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 1:11000 NE 10TH ST APT 134
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-8557
Mailing Address - Country:US
Mailing Address - Phone:281-691-0603
Mailing Address - Fax:
Practice Address - Street 1:70 PRINCETON DR
Practice Address - Street 2:UNIT 303
Practice Address - City:HOOKSETT
Practice Address - State:NH
Practice Address - Zip Code:03106-1741
Practice Address - Country:US
Practice Address - Phone:617-785-9824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-20
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH04082122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist