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General NPI Number Information
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NPI Number | 1073725891
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Entity Type | Individual
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Provider Name | SEOKWOO LEE DDS
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Gender | Male
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 11/11/2008
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Provider Practice Location Address
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Address Line | 10750 QUEENS BLVD
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City | FOREST HILLS
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State | NY
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Zip | 11375-4251
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Country | US
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Telephone | 718-793-1777
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Fax | 718-544-5123
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Provider Business Mailing Address
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Address Line | 13131 BROOKTREE LN
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City | LAUREL
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State | MD
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Zip | 20707-9499
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Country | US
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Telephone | 410-465-0508
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 053448-1
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License Number State | NY
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