Healthcare Provider Details

I. General information

NPI: 1922789411
Provider Name (Legal Business Name): SANG HEE LEE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 SUMMIT AVE
HACKENSACK NJ
07601-1218
US

IV. Provider business mailing address

20206 TOWN GREEN DR
ELMSFORD NY
10523-1681
US

V. Phone/Fax

Practice location:
  • Phone: 201-996-0770
  • Fax:
Mailing address:
  • Phone: 703-909-8239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI02987100
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: