Provider Demographics
NPI:1336532712
Name:LEE, SOONJAE (DMD)
Entity type:Individual
Prefix:DR
First Name:SOONJAE
Middle Name:
Last Name:LEE
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 WILMINGTON W CHESTER PIKE STE 202
Mailing Address - Street 2:
Mailing Address - City:CHADDS FORD
Mailing Address - State:PA
Mailing Address - Zip Code:19317-9011
Mailing Address - Country:US
Mailing Address - Phone:267-270-5658
Mailing Address - Fax:
Practice Address - Street 1:225 WILMINGTON W CHESTER PIKE STE 202
Practice Address - Street 2:
Practice Address - City:CHADDS FORD
Practice Address - State:PA
Practice Address - Zip Code:19317-9011
Practice Address - Country:US
Practice Address - Phone:267-270-5658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-10
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0402811223D0004X
NJ22DI026594001223D0004X
DEG1-00014391223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDental Anesthesiology