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General NPI Number Information
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NPI Number | 1114485745
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Entity Type | Organization
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Legal Business Name | JIN KUK LEE DDS INC
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Dates
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Enumeration Date | 03/01/2019
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Last Update Date | 03/01/2019
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Provider Practice Location Address
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Address Line | 2440 N JOSEY LN STE 103
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City | CARROLLTON
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State | TX
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Zip | 75006-1697
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Country | US
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Telephone | 972-427-2875
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Fax | 214-764-0165
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Provider Business Mailing Address
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Address Line | 11445 EMERALD ST STE 112
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City | DALLAS
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State | TX
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Zip | 75229-7315
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | JIN KUK LEE
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Credential |
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Telephone | 310-968-6125
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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 |
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License Number State |
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