Provider Demographics
NPI:1982918223
Name:LEE, JUNG HO (DDS)
Entity type:Individual
Prefix:DR
First Name:JUNG HO
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 1:3901 KINGSBURY LN SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-3082
Mailing Address - Country:US
Mailing Address - Phone:360-754-9300
Mailing Address - Fax:360-754-0220
Practice Address - Street 1:2962 LIMITED LN NW STE B
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-4550
Practice Address - Country:US
Practice Address - Phone:360-754-9300
Practice Address - Fax:360-754-0220
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-28
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE601726171223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice