Healthcare Provider Details

I. General information

NPI: 1952206146
Provider Name (Legal Business Name): JAEHYUN LEE DMD, MSD, MAS, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAE-HYUN LEE DMD, MSD, MAS, PHD

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 LONGWOOD AVE
BOSTON MA
02115-5888
US

IV. Provider business mailing address

188 LONGWOOD AVE REB 222
BOSTON MA
02115-5819
US

V. Phone/Fax

Practice location:
  • Phone: 617-432-1434
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDF100086
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: