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General NPI Number Information
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NPI Number | 1245886894
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Entity Type | Individual
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Provider Name | JU YONG LEE DDS
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Gender | Male
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Dates
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Enumeration Date | 08/09/2019
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Last Update Date | 01/09/2026
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Provider Practice Location Address
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Address Line | 4325 AIRLINE DR
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City | BOSSIER CITY
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State | LA
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Zip | 71111-2003
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Country | US
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Telephone | 318-742-9333
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Fax | 318-747-9089
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Provider Business Mailing Address
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Address Line | 4335 S GRAND CANYON DR UNIT 442
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City | LAS VEGAS
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State | NV
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Zip | 89147-7194
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 7748
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 104283
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | S6-238C
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License Number State | NV
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