Healthcare Provider Details

I. General information

NPI: 1255487112
Provider Name (Legal Business Name): JOHN LEE D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19316 NORTHERN BLVD STE D
FLUSHING NY
11358-2900
US

IV. Provider business mailing address

19316 NORTHERN BLVD STE D
FLUSHING NY
11358-2900
US

V. Phone/Fax

Practice location:
  • Phone: 347-438-1000
  • Fax:
Mailing address:
  • Phone: 347-438-1000
  • Fax: 347-438-1002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number052270-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: