MEDICARE: JAE WOO LEE

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	DN123111	GA

General Provider Information

NPI Number	:	1548990005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAE WOO LEE

Provider Business Mailing Address
First Line	:	105 PROFESSIONAL CT SE
Second Line	:
City	:	CALHOUN
State	:	GA
Zip	:	30701-7036
Country	:	US
Telephone Number	:	917-745-2019
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 PROFESSIONAL CT SE
Second Line	:
City	:	CALHOUN
State	:	GA
Zip	:	30701-7036
Country	:	US
Telephone Number	:	917-745-2019
Fax Number	:

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

Provider Enumeration Date	:	06/15/2022
Last Update Date	:	03/17/2026

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Directions to “ JAE WOO LEE ” Practice Location

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