Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 053448-1 | NY |
NPI | 1073725891 |
---|---|
Provider Name | Seokwoo Lee |
First Address | Laurel, MD 20707-9499 |
Second Address | Forest Hills, NY 11375-4251 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 11/11/2008 |