Healthcare Provider Details

I. General information

NPI: 1407821994
Provider Name (Legal Business Name): JENNY MYUNGWON LEE DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 MAIN ST.
KLAMATH FALLS OR
97601
US

IV. Provider business mailing address

808 MAIN ST.
KLAMATH FALLS OR
97601
US

V. Phone/Fax

Practice location:
  • Phone: 541-884-8668
  • Fax: 541-885-4854
Mailing address:
  • Phone: 541-884-8668
  • Fax: 541-885-4854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberD6752
License Number StateOR

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: