Provider Demographics
NPI:1689752677
Name:LEE, CHONG YOON (DDS)
Entity type:Individual
Prefix:
First Name:CHONG
Middle Name:YOON
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 1:13270 ROSE ST
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-8644
Mailing Address - Country:US
Mailing Address - Phone:562-322-8608
Mailing Address - Fax:
Practice Address - Street 1:13270 ROSE ST
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-8644
Practice Address - Country:US
Practice Address - Phone:562-322-8608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34986122300000X
CO7579122300000X
WADE 60303875122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist