Provider Demographics
NPI:1346521200
Name:LEE, JUNG HYUN (DMD)
Entity Type:Individual
Prefix:
First Name:JUNG
Middle Name:HYUN
Last Name:LEE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 SAINT MICHAELS WALK
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-3367
Mailing Address - Country:US
Mailing Address - Phone:401-749-1545
Mailing Address - Fax:
Practice Address - Street 1:280 N CENTRAL AVE STE 420
Practice Address - Street 2:
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-1842
Practice Address - Country:US
Practice Address - Phone:914-874-5121
Practice Address - Fax:914-874-5122
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057825122300000X
MADN1855864122300000X
RIDEN031081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes122300000XDental ProvidersDentist