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General NPI Number Information
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NPI Number | 1457198202
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Entity Type | Individual
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Provider Name | HA EUN LEE
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Gender | Female
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Dates
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Enumeration Date | 07/10/2024
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Last Update Date | 08/13/2024
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Provider Practice Location Address
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Address Line | 2690 NE KRESKY AVE
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City | CHEHALIS
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State | WA
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Zip | 98532-2412
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Country | US
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Telephone | 360-330-9595
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Fax | 360-330-9580
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Provider Business Mailing Address
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Address Line | 5485 15TH AVE NE UNIT E108
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City | LACEY
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State | WA
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Zip | 98516-3019
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Country | US
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Telephone | 903-787-4847
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DE61573683
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License Number State | WA
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