Healthcare Provider Details

I. General information

NPI: 1538860242
Provider Name (Legal Business Name): SANGJEA LEE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2023
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 ESSEX ST
BOSTON MA
02111-2618
US

IV. Provider business mailing address

183 ESSEX ST
BOSTON MA
02111-2618
US

V. Phone/Fax

Practice location:
  • Phone: 617-286-6515
  • Fax: 877-497-4451
Mailing address:
  • Phone: 617-286-6515
  • Fax: 877-497-4451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN1859976
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberDN1859976
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberDN1859976
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: