Provider Demographics
NPI:1770839367
Name:LEE, JOSHUA PYUNGHOON
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:PYUNGHOON
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 1:210 WINTHROP RD
Mailing Address - Street 2:APT 12A
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-4424
Mailing Address - Country:US
Mailing Address - Phone:443-538-4129
Mailing Address - Fax:
Practice Address - Street 1:389 MAIN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-5017
Practice Address - Country:US
Practice Address - Phone:781-322-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15108122300000X
MADN1856823122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist