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General NPI Number Information
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NPI Number | 1528790375
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Entity Type | Individual
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Provider Name | DR. HYUNJAE LEE
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Gender | Male
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Dates
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Enumeration Date | 06/29/2022
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Last Update Date | 06/29/2022
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Provider Practice Location Address
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Address Line | 1620 MAIN ST NW STE D
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City | LOS LUNAS
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State | NM
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Zip | 87031-4891
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Country | US
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Telephone | 505-565-0651
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Fax |
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Provider Business Mailing Address
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Address Line | 863 SILVER AVE SW
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-3020
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Country | US
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Telephone | 949-940-5833
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DD5659
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License Number State | NM
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