Healthcare Provider Details

I. General information

NPI: 1932700671
Provider Name (Legal Business Name): K.LEE, DDS, PLLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20709 MOUNTAIN HWY E # 102
SPANAWAY WA
98387-8580
US

IV. Provider business mailing address

20709 MOUNTAIN HWY E # 102
SPANAWAY WA
98387-8580
US

V. Phone/Fax

Practice location:
  • Phone: 253-294-7047
  • Fax: 253-387-8899
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KWANSOO LEE
Title or Position: DENTIST
Credential: DDS
Phone: 253-294-7047