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General NPI Number Information
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NPI Number | 1336125442
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Entity Type | Individual
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Provider Name | KWANG MYUNG SIMON LEE DMD
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Gender | Male
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Dates
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Enumeration Date | 12/20/2005
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Last Update Date | 02/21/2025
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Provider Practice Location Address
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Address Line | 724 KAKALA ST UNIT 1401
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City | KAPOLEI
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State | HI
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Zip | 96707-4632
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Country | US
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Telephone | 808-353-8433
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Fax | 808-638-3374
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Provider Business Mailing Address
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Address Line | 724 KAKALA ST UNIT 1401
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City | KAPOLEI
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State | HI
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Zip | 96707-4632
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Country | US
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Telephone | 808-353-8433
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Fax | 808-638-3374
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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 | DS030250L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DT-2275
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License Number State | HI
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