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General NPI Number Information
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NPI Number | 1376820365
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Entity Type | Individual
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Provider Name | JIN KUK LEE DDS
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Gender | Male
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Dates
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Enumeration Date | 11/04/2011
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Last Update Date | 05/18/2016
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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 | 310-968-6125
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Fax |
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Provider Business Mailing Address
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Address Line | 5945 W PARKER RD APT 1114
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City | PLANO
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State | TX
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Zip | 75093-7759
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Country | US
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Telephone | 310-968-6125
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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 | 27513
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE60242044
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License Number State | WA
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