Provider Demographics
NPI:1699145599
Name:LEE, WOOJIN (DDS)
Entity type:Individual
Prefix:DR
First Name:WOOJIN
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 1:1 BROOKDALE PLZ
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212
Mailing Address - Country:US
Mailing Address - Phone:718-240-6552
Mailing Address - Fax:718-240-6069
Practice Address - Street 1:1 BROOKDALE PLZ
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212
Practice Address - Country:US
Practice Address - Phone:718-240-6552
Practice Address - Fax:718-240-6069
Is Sole Proprietor?:No
Enumeration Date:2015-10-05
Last Update Date:2021-01-12
Deactivation Date:2017-12-27
Deactivation Code:
Reactivation Date:2018-01-04
Provider Licenses
StateLicense IDTaxonomies
MD162121223G0001X
MI29010217431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice