Healthcare Provider Details

I. General information

NPI: 1861517534
Provider Name (Legal Business Name): JAMES JONG-HYUK LEE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N VISTA RIDGE BLVD STE 100
CEDAR PARK TX
78613-2425
US

IV. Provider business mailing address

111 N VISTA RIDGE BLVD STE 100
CEDAR PARK TX
78613-2425
US

V. Phone/Fax

Practice location:
  • Phone: 512-250-2356
  • Fax: 512-532-6516
Mailing address:
  • Phone: 512-250-2356
  • Fax: 512-532-6516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number19039
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: