Healthcare Provider Details

I. General information

NPI: 1154847044
Provider Name (Legal Business Name): NA WON LEE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 THIELLS MOUNT IVY RD STE 103
POMONA NY
10970-3021
US

IV. Provider business mailing address

222 E 34TH ST APT 1409
NEW YORK NY
10016-9828
US

V. Phone/Fax

Practice location:
  • Phone: 845-400-2577
  • Fax:
Mailing address:
  • Phone: 347-820-1663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number061691
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: