Provider Demographics
NPI:1871812834
Name:LEE, JOO-YONG (DDS)
Entity type:Individual
Prefix:
First Name:JOO-YONG
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6230 NORTHVIEW LN
Mailing Address - Street 2:#8
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-4787
Mailing Address - Country:US
Mailing Address - Phone:909-202-3097
Mailing Address - Fax:419-478-4856
Practice Address - Street 1:5801 TELEGRAPH RD
Practice Address - Street 2:SUITE 1
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43612-4557
Practice Address - Country:US
Practice Address - Phone:419-478-4440
Practice Address - Fax:419-478-4856
Is Sole Proprietor?:No
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-023175122300000X
CA59124122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist