Provider Demographics
NPI:1215343512
Name:LEE, BOUNGHOON (DDS)
Entity type:Individual
Prefix:
First Name:BOUNGHOON
Middle Name:
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 1:7439 E CONQUISTADORES DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-5069
Mailing Address - Country:US
Mailing Address - Phone:734-778-0904
Mailing Address - Fax:
Practice Address - Street 1:5220 N DYSART RD STE 108
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-3046
Practice Address - Country:US
Practice Address - Phone:623-547-0011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.024403122300000X
MI2901021330122300000X
AZAZ009869122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist