Provider Demographics
NPI:1972044055
Name:LEE, YUJIN (DMD)
Entity Type:Individual
Prefix:
First Name:YUJIN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 ISLAND HILL AVE UNIT 209
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-6115
Mailing Address - Country:US
Mailing Address - Phone:949-302-0763
Mailing Address - Fax:
Practice Address - Street 1:14 ISLAND HILL AVE UNIT 209
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-6115
Practice Address - Country:US
Practice Address - Phone:949-302-0763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-09
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18579201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice