Provider Demographics
NPI:1720575020
Name:LEE, ANABELLE MOEUN (DMD, MPH)
Entity Type:Individual
Prefix:
First Name:ANABELLE
Middle Name:MOEUN
Last Name:LEE
Suffix:
Gender:F
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:ANABELLE
Other - Middle Name:MOEUN
Other - Last Name:CHUN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:561 10TH AVE APT 45A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-3060
Mailing Address - Country:US
Mailing Address - Phone:909-331-8046
Mailing Address - Fax:
Practice Address - Street 1:164 W 96TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6402
Practice Address - Country:US
Practice Address - Phone:212-998-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY060783122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program