Provider Demographics
NPI:1386845543
Name:LEE, KERN HO (DDS)
Entity Type:Individual
Prefix:DR
First Name:KERN
Middle Name:HO
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3600 FIELDSTON RD
Mailing Address - Street 2:2C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-2004
Mailing Address - Country:US
Mailing Address - Phone:718-884-2600
Mailing Address - Fax:718-543-2028
Practice Address - Street 1:3600 FIELDSTON RD
Practice Address - Street 2:2C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-2004
Practice Address - Country:US
Practice Address - Phone:718-884-2600
Practice Address - Fax:718-543-2028
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY42372-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01172045Medicaid