Provider Demographics
NPI:1093445108
Name:LEE, YUN JE (DMD)
Entity Type:Individual
Prefix:DR
First Name:YUN
Middle Name:JE
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 1:6075 NIAGARA LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-4540
Mailing Address - Country:US
Mailing Address - Phone:763-248-0680
Mailing Address - Fax:
Practice Address - Street 1:9220 BASS LAKE RD STE 345
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:MN
Practice Address - Zip Code:55428-3095
Practice Address - Country:US
Practice Address - Phone:763-248-0680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND147601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice