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General NPI Number Information
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NPI Number | 1619124633
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Entity Type | Individual
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Provider Name | SUNG MIN LEE D.D.S
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Gender | Female
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Dates
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Enumeration Date | 08/20/2008
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Last Update Date | 03/09/2023
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Provider Practice Location Address
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Address Line | 34 FRANKLIN CORNER RD
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City | LAWRENCEVILLE
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State | NJ
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Zip | 08648-2102
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Country | US
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Telephone | 98-883-6900
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Fax |
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Provider Business Mailing Address
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Address Line | 2030 HUDSON ST APT 723
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City | FORT LEE
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State | NJ
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Zip | 07024-7218
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Country | US
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Telephone | 201-638-2071
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 054195-01
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 22DI02376100
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License Number State | NJ
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