Provider Demographics
NPI:1922175637
Name:LEE, EUN-JUNG LINDA (DDS)
Entity Type:Individual
Prefix:DR
First Name:EUN-JUNG
Middle Name:LINDA
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 1:8274 COUNTRY POINTE CIR # 2
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11427-3002
Mailing Address - Country:US
Mailing Address - Phone:917-922-3406
Mailing Address - Fax:
Practice Address - Street 1:3973 61ST ST
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-3554
Practice Address - Country:US
Practice Address - Phone:718-429-5656
Practice Address - Fax:718-458-5205
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049543122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist