Healthcare Provider Details

I. General information

NPI: 1043659105
Provider Name (Legal Business Name): YOUNG MIN LEE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 07/21/2022
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15726 1ST AVE S
BURIEN WA
98148-1211
US

IV. Provider business mailing address

3118 S 279TH ST
AUBURN WA
98001-1941
US

V. Phone/Fax

Practice location:
  • Phone: 206-988-0500
  • Fax:
Mailing address:
  • Phone: 951-235-1230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number60707787
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number62454
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: