MEDICARE: DR. KYUNG E LEE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	053234	NY

General Provider Information

NPI Number	:	1063605780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KYUNG E LEE DDS

Provider Business Mailing Address
First Line	:	350 S 38TH CT STE 215
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98055-5777
Country	:	US
Telephone Number	:	716-316-2330
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 S 38TH CT STE 215
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98055-5777
Country	:	US
Telephone Number	:	716-316-2330
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2007
Last Update Date	:	10/09/2015

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