Healthcare Provider Details

I. General information

NPI: 1467439604
Provider Name (Legal Business Name): SUNG YONG LEE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JARRETT WHITE ROAD ATTN: MCDS-NH , US ARMY DENTAL ACTIVITY HAWAII
TRIPLER AMC HI
96859-5000
US

IV. Provider business mailing address

1 JARRETT WHITE ROAD ATTN: MCDS-NH ,US ARMY DENTAL ACTIVITY HAWAII
TRIPLER AMC HI
96859-5000
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-1021
  • Fax: 808-433-3928
Mailing address:
  • Phone: 808-433-1021
  • Fax: 808-433-3928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDT1874
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: