Healthcare Provider Details

I. General information

NPI: 1356021687
Provider Name (Legal Business Name): SEO-YUN LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2023
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date: 06/10/2024
Reactivation Date: 08/05/2026

III. Provider practice location address

1175 MAIN ST
CLINTON MA
01510-1130
US

IV. Provider business mailing address

1175 MAIN ST
CLINTON MA
01510-1130
US

V. Phone/Fax

Practice location:
  • Phone: 978-733-0045
  • Fax:
Mailing address:
  • Phone: 978-733-0045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN10001478
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: