Provider Demographics
NPI:1699000547
Name:LEE, JIEUN (DMD)
Entity type:Individual
Prefix:DR
First Name:JIEUN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8TH MEDICAL GROUP UNIT 2022
Mailing Address - Street 2:KUNSAN AB
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96264-2022
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8TH MEDICAL GROUP UNIT 2022
Practice Address - Street 2:KUNSAN AB
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96264-2022
Practice Address - Country:US
Practice Address - Phone:315-782-7705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-09
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0380981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice