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General NPI Number Information
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NPI Number | 1093381139
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Entity Type | Individual
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Provider Name | SUJEONG LEE DMD
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Gender | Female
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Dates
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Enumeration Date | 05/30/2021
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 8092 EDWIN RAYNOR BLVD
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City | PASADENA
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State | MD
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Zip | 21122-6833
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Country | US
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Telephone | 718-579-6095
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Fax |
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Provider Business Mailing Address
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Address Line | 234 E 149TH ST
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City | BRONX
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State | NY
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Zip | 10451-5504
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 18411
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License Number State | MD
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