MEDICARE: DR. JONATHAN JUNGHO LEE D.M.D

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	22160	MA

General Provider Information

NPI Number	:	1144481094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN JUNGHO LEE D.M.D

Provider Business Mailing Address
First Line	:	1892 CENTRE ST
Second Line	:
City	:	WEST ROXBURY
State	:	MA
Zip	:	02132-1924
Country	:	US
Telephone Number	:	617-327-1350
Fax Number	:	617-477-3394

Provider Business Practice Location Address
First Line	:	1892 CENTRE ST
Second Line	:
City	:	WEST ROXBURY
State	:	MA
Zip	:	02132-1924
Country	:	US
Telephone Number	:	617-327-1350
Fax Number	:	617-477-3394

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

Provider Enumeration Date	:	06/23/2008
Last Update Date	:	05/05/2026

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