Individual
KENNETH LEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3210 W 63RD ST, CHICAGO, IL 60629-3325
(773) 776-8300
Mailing address
2 BAY CLUB DR APT 16K, BAYSIDE, NY 11360-2930
(347) 551-4311
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019.033918
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
IL
Other
Enumeration date
07/05/2022
Last updated
08/24/2023
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