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NPI Code Detail

MEDICARE: DR. CHEOLSOO LEE DDS

MEDICARE: DR. CHEOLSOO LEE DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist2022022940MO

General Provider Information

NPI Number : 1336877539
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHEOLSOO LEE DDS
Provider Business Mailing Address
First Line : 5314 W 121ST TER APT 212
Second Line :
City : OVERLAND PARK
State : KS
Zip : 66209-3568
Country : US
Telephone Number : 602-334-9225
Fax Number :
Provider Business Practice Location Address
First Line : 3908 S NOLAND RD
Second Line :
City : INDEPENDENCE
State : MO
Zip : 64055-3347
Country : US
Telephone Number : 816-461-2273
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2022
Last Update Date : 08/15/2022

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Directions to “ DR. CHEOLSOO LEE DDS” Practice Location

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