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1699189431 NPI number — JUDYTH GRACE LEE DMD

NPI Number: 1699189431
Health Care Provider/Practitioner: JUDYTH GRACE LEE DMD

Information about “1699189431” NPI (JUDYTH GRACE LEE DMD) exists in 1699189431 in HTML format HTML  |  1699189431 in plain Text format TXT  |  1699189431 in PDF (Portable Document Format) PDF  |  1699189431 in an XML format XML  formats.

NPI Number : 1699189431 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1699189431",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LEE",
    "FirstName": "JUDYTH",
    "MiddleName": "GRACE",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DMD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "451 KANSAS ST UNIT 558",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAN FRANCISCO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "94107-2218",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "706-988-2187",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "520 LENNON LN STE A",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WALNUT CREEK",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "94598-2415",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "925-930-9390",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/19/2014",
    "LastUpdateDate": "06/20/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "1223P0221X",
          "TaxonomyName": "Pediatric Dentistry",
          "LicenseNumber": "22DI02638100",
          "LicenseNumberStateCode": "NJ",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1223P0221X",
          "TaxonomyName": "Pediatric Dentistry",
          "LicenseNumber": "058674",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1223P0221X",
          "TaxonomyName": "Pediatric Dentistry",
          "LicenseNumber": "DDS103376",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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