MEDICARE: SEUNG-JUN LEE D.D.S.

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
1	1223P0300X	Periodontics	29736	TX
2	1223P0300X	Periodontics	60903	CA

General Provider Information

NPI Number	:	1356691638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEUNG-JUN LEE D.D.S.

Provider Business Mailing Address
First Line	:	2651 TEXAS DR
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75062-7016
Country	:	US
Telephone Number	:	972-255-4164
Fax Number	:	972-252-1580

Provider Business Practice Location Address
First Line	:	2651 TEXAS DR
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75062-7016
Country	:	US
Telephone Number	:	972-255-4164
Fax Number	:	972-252-1580

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2012
Last Update Date	:	07/09/2014

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Directions to “ SEUNG-JUN LEE D.D.S.” Practice Location

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