Healthcare Provider Details

I. General information

NPI: 1093401697
Provider Name (Legal Business Name): HAN SHENG LEE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 JEFFERSON AVE
ELIZABETH NJ
07201-2474
US

IV. Provider business mailing address

50 LEXINGTON AVE APT 12C
NEW YORK NY
10010-2930
US

V. Phone/Fax

Practice location:
  • Phone: 190-846-9910
  • Fax:
Mailing address:
  • Phone: 469-954-3857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number22DI03106300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: