Provider Demographics
NPI:1952377483
Name:LEE, CYRUS JEH (DMD)
Entity type:Individual
Prefix:DR
First Name:CYRUS
Middle Name:JEH
Last Name:LEE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:586 NE 60TH AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-7293
Mailing Address - Country:US
Mailing Address - Phone:503-419-6328
Mailing Address - Fax:
Practice Address - Street 1:19075 NW TANASBOURNE DRIVE
Practice Address - Street 2:SUITE 300 KAISER PERMANENTE DENTAL OFFICE
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-0000
Practice Address - Country:US
Practice Address - Phone:503-531-1700
Practice Address - Fax:503-531-1704
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000094931223G0001X
ORD87021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice