Healthcare Provider Details

I. General information

NPI: 1962482380
Provider Name (Legal Business Name): JOHN KEUN LEE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

464 VALLEY BROOK AVE FL 2A
LYNDHURST NJ
07071-1995
US

IV. Provider business mailing address

244 UNDERCLIFF AVE
EDGEWATER NJ
07020-1590
US

V. Phone/Fax

Practice location:
  • Phone: 201-933-9092
  • Fax: 201-932-0112
Mailing address:
  • Phone: 412-897-5118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI02463200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: