Provider Demographics
NPI:1215428677
Name:LEE, ALLISON YUKYUNG (DDS)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:YUKYUNG
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:YU
Other - Middle Name:KYUNG
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1800 N FIELD ST APT 3002
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75202-0001
Mailing Address - Country:US
Mailing Address - Phone:815-275-9455
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL DENTISTRY
Practice Address - Street 2:151 WESTCHESTER HALL
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11704-8711
Practice Address - Country:US
Practice Address - Phone:631-444-2557
Practice Address - Fax:631-444-6013
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX376041223G0001X, 1223D0004X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDental Anesthesiology
No1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program