Provider Demographics
NPI:1285926683
Name:LEE, WOO YOUNG
Entity type:Individual
Prefix:DR
First Name:WOO
Middle Name:YOUNG
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1674 PACIFIC COAST HWY
Mailing Address - Street 2:
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-2628
Mailing Address - Country:US
Mailing Address - Phone:310-326-9696
Mailing Address - Fax:
Practice Address - Street 1:1674 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-2628
Practice Address - Country:US
Practice Address - Phone:310-326-9696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA278981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice