Provider Demographics
NPI:1376982108
Name:LEE, JOOHYUN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOOHYUN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 HACKENSACK AVE APT 2405
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-6339
Mailing Address - Country:US
Mailing Address - Phone:631-807-2722
Mailing Address - Fax:
Practice Address - Street 1:210 KNICKERBOCKER RD
Practice Address - Street 2:
Practice Address - City:CRESSKILL
Practice Address - State:NJ
Practice Address - Zip Code:07626-1801
Practice Address - Country:US
Practice Address - Phone:201-567-3990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057839122300000X
NJ22DI02644200122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist