Provider Demographics
NPI:1003259631
Name:LEE, JIM MING-AN (MPH, DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JIM
Middle Name:MING-AN
Last Name:LEE
Suffix:
Gender:M
Credentials:MPH, DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20002 FARMINGDALE CT
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-4055
Mailing Address - Country:US
Mailing Address - Phone:202-423-8867
Mailing Address - Fax:
Practice Address - Street 1:7360 GUILFORD DR
Practice Address - Street 2:STE #102
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-5124
Practice Address - Country:US
Practice Address - Phone:301-668-2662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-13
Last Update Date:2013-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD152591223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics