Provider Demographics
NPI:1194049072
Name:LEE, DAVID DOO-SANG (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:DOO-SANG
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 1:9953 W TARON DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-8160
Mailing Address - Country:US
Mailing Address - Phone:718-640-4317
Mailing Address - Fax:
Practice Address - Street 1:1745 W KETTLEMAN LN
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-9287
Practice Address - Country:US
Practice Address - Phone:718-640-4317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-20
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054819122300000X
CT0102411223G0001X
CADDS1010141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist