Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN00000448 | WA |
NPI | 1922293471 |
---|---|
Provider Name | Dr. Jin U Lee |
First Address | Lynnwood, WA 98037-4499 |
Second Address | Lynnwood, WA 98037-4499 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2007 |
Last Update Date | 07/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5053442 | (05) | WA |