Provider Demographics
NPI:1427463785
Name:LEE, YONG WOO (DMD)
Entity type:Individual
Prefix:
First Name:YONG WOO
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 ROB ROY LN
Mailing Address - Street 2:UNIT B
Mailing Address - City:PROSPECT HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60070-3437
Mailing Address - Country:US
Mailing Address - Phone:847-668-1106
Mailing Address - Fax:
Practice Address - Street 1:7310 WALTON ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-4614
Practice Address - Country:US
Practice Address - Phone:847-668-1106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190298461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice