Provider Demographics
NPI:1245359587
Name:LEE, IVAN (DDS)
Entity type:Individual
Prefix:DR
First Name:IVAN
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:IVAN
Other - Middle Name:TATSUM
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7 CHATHAM SQ
Mailing Address - Street 2:SUITE 305
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-1000
Mailing Address - Country:US
Mailing Address - Phone:212-385-9480
Mailing Address - Fax:212-587-6110
Practice Address - Street 1:7 CHATHAM SQ
Practice Address - Street 2:SUITE 305
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-1000
Practice Address - Country:US
Practice Address - Phone:212-385-9480
Practice Address - Fax:212-587-6110
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY385791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice