Healthcare Provider Details

I. General information

NPI: 1407983612
Provider Name (Legal Business Name): HEEJUN KATHY LEE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHY LEE DDS

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 W PADONIA RD SUITE C244
TIMONIUM MD
21093-2226
US

IV. Provider business mailing address

8 SAGEWOOD CT
SPARKS MD
21152-9304
US

V. Phone/Fax

Practice location:
  • Phone: 410-252-3900
  • Fax: 410-252-6051
Mailing address:
  • Phone: 410-472-9284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number12206
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: