Provider Demographics
NPI:1194887364
Name:LEE, WONJOO (DDS)
Entity type:Individual
Prefix:DR
First Name:WONJOO
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3540 GRAND AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-2010
Mailing Address - Country:US
Mailing Address - Phone:510-208-3012
Mailing Address - Fax:510-208-4524
Practice Address - Street 1:3540 GRAND AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-2010
Practice Address - Country:US
Practice Address - Phone:510-208-3012
Practice Address - Fax:510-208-4524
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA499231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice