MEDICARE: DR. VIVIAN LEE DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019.035322	IL

General Provider Information

NPI Number	:	1073206942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIVIAN LEE DMD

Provider Business Mailing Address
First Line	:	200 N ARLINGTON HEIGHTS RD APT 907
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-6052
Country	:	US
Telephone Number	:	224-475-3236
Fax Number	:

Provider Business Practice Location Address
First Line	:	107 W LAKE ST
Second Line	:
City	:	BLOOMINGDALE
State	:	IL
Zip	:	60108-1027
Country	:	US
Telephone Number	:	630-307-3133
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2023
Last Update Date	:	06/06/2026

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Directions to “ DR. VIVIAN LEE DMD” Practice Location

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