Healthcare Provider Details

I. General information

NPI: 1497667349
Provider Name (Legal Business Name): HYUNJIN LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EMILY LEE DDS

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 W VAN BUREN ST APT 1708
CHICAGO IL
60607-3251
US

IV. Provider business mailing address

1044 W VAN BUREN ST APT 1708
CHICAGO IL
60607-3251
US

V. Phone/Fax

Practice location:
  • Phone: 616-401-4867
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number319.025532
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: