Healthcare Provider Details

I. General information

NPI: 1508542697
Provider Name (Legal Business Name): YEONJI LEE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E 40TH ST RM 806
NEW YORK NY
10016-1212
US

IV. Provider business mailing address

30 E 40TH ST RM 806
NEW YORK NY
10016-1212
US

V. Phone/Fax

Practice location:
  • Phone: 646-624-0987
  • Fax:
Mailing address:
  • Phone: 646-624-0987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number065450
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: