Provider Demographics
NPI:1972970119
Name:LEE, KYU (DDS)
Entity type:Individual
Prefix:
First Name: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 1:3341 WARRENSVILLE CENTER RD
Mailing Address - Street 2:APT 301
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-3716
Mailing Address - Country:US
Mailing Address - Phone:614-596-4201
Mailing Address - Fax:330-753-5888
Practice Address - Street 1:1575 VERNON ODOM BLVD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-4091
Practice Address - Country:US
Practice Address - Phone:330-753-7734
Practice Address - Fax:330-753-5888
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.024603122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist