Provider Demographics
NPI:1407417512
Name:LEE, DONG HYUN
Entity Type:Individual
Prefix:
First Name:DONG HYUN
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 BANK ST APT 1013
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10606-2057
Mailing Address - Country:US
Mailing Address - Phone:646-321-7043
Mailing Address - Fax:
Practice Address - Street 1:516 ROUTE 303
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:NY
Practice Address - Zip Code:10962-1352
Practice Address - Country:US
Practice Address - Phone:845-613-4197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2023-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062022122300000X
MO2019023448122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist