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General NPI Number Information
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NPI Number | 1750765111
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Entity Type | Individual
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Provider Name | GYUHO LEE D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/16/2015
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Last Update Date | 07/16/2015
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Provider Practice Location Address
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Address Line | 1325 W AIRY ST
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City | NORRISTOWN
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State | PA
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Zip | 19401-4357
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Country | US
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Telephone | 610-275-1565
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 LOCUST ST APT 3004
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City | PHILADELPHIA
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State | PA
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Zip | 19102-4322
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Country | US
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Telephone | 609-558-5097
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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 | DS040534
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License Number State | PA
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