Provider Demographics
NPI:1316305048
Name:LEE, SUNG KYU (DDS)
Entity type:Individual
Prefix:DR
First Name:SUNG KYU
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 1:2125 S BREA CANYON RD
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-4019
Mailing Address - Country:US
Mailing Address - Phone:909-861-8996
Mailing Address - Fax:909-861-8993
Practice Address - Street 1:2125 S BREA CANYON RD
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-4019
Practice Address - Country:US
Practice Address - Phone:909-861-8996
Practice Address - Fax:909-861-8993
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-09
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA616841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice