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General NPI Number Information
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NPI Number | 1811703614
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Entity Type | Individual
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Provider Name | DONG CHAN LEE DDS
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Gender | Male
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Dates
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Enumeration Date | 12/06/2024
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 5003 TACOMA MALL BLVD STE 103
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City | TACOMA
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State | WA
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Zip | 98409-7120
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Country | US
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Telephone | 253-759-3366
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Fax |
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Provider Business Mailing Address
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Address Line | 2515 JEFFERSON AVE APT 303
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City | TACOMA
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State | WA
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Zip | 98402-1318
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Country | US
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Telephone | 209-933-1119
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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 | 61580469
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License Number State | WA
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