Provider Demographics
NPI:1992974778
Name:LEE, YOUNG SEOP (DDS)
Entity type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:SEOP
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15224 MAIN STREET
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012
Mailing Address - Country:US
Mailing Address - Phone:425-338-4999
Mailing Address - Fax:425-338-1055
Practice Address - Street 1:15224 MAIN STREET
Practice Address - Street 2:SUITE 301EVERGREEN FAMILY DENTAL
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012
Practice Address - Country:US
Practice Address - Phone:425-338-4999
Practice Address - Fax:425-338-1055
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00008790122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist