Healthcare Provider Details

I. General information

NPI: 1841355872
Provider Name (Legal Business Name): DONALD Y. LEE DDS PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 05/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4957 LAKEMONT BLVD SE, C-4
BELLEVUE WA
98006-7801
US

IV. Provider business mailing address

4957 LAKEMONT BLVD SE, C-4
BELLEVUE WA
98006-7801
US

V. Phone/Fax

Practice location:
  • Phone: 425-401-1366
  • Fax: 425-223-5612
Mailing address:
  • Phone: 425-401-1366
  • Fax: 425-223-5612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDE00008487
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberGA 10000276
License Number StateWA

VIII. Authorized Official

Name: DONALD LEE
Title or Position: PRESIDENT
Credential: DDS, PS
Phone: 425-401-1366