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General NPI Number Information
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NPI Number | 1093208514
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Entity Type | Individual
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Provider Name | SUNGGYU LEE DMD
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Gender | Male
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Dates
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Enumeration Date | 06/09/2018
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Last Update Date | 06/09/2018
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Provider Practice Location Address
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Address Line | 15207 PEARL RD
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City | STRONGSVILLE
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State | OH
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Zip | 44136-5020
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Country | US
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Telephone | 440-572-4840
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Fax | 440-572-3814
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Provider Business Mailing Address
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Address Line | 12300 FARINACCI CT APT 3
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City | CLEVELAND
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State | OH
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Zip | 44106-5966
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Country | US
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Telephone | 330-554-8056
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 30.025480
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License Number State | OH
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