Provider Demographics
NPI:1346658192
Name:LEE, JAE YONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAE
Middle Name:YONG
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8010 MCGINNIS FERRY RD STE F
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-5137
Mailing Address - Country:US
Mailing Address - Phone:770-765-2815
Mailing Address - Fax:
Practice Address - Street 1:8010 MCGINNIS FERRY RD STE F
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-5137
Practice Address - Country:US
Practice Address - Phone:770-765-2815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI025773001223G0001X
GADN0160981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice