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General NPI Number Information
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NPI Number | 1720575020
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Entity Type | Individual
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Provider Name | ANABELLE MOEUN LEE DMD, MPH
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Gender | Female
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Dates
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Enumeration Date | 04/23/2018
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Last Update Date | 12/11/2019
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Provider Practice Location Address
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Address Line | 164 W 96TH ST
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City | NEW YORK
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State | NY
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Zip | 10025-6402
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Country | US
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Telephone | 212-998-9800
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Fax |
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Provider Business Mailing Address
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Address Line | 561 10TH AVE APT 45A
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City | NEW YORK
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State | NY
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Zip | 10036-3060
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Country | US
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Telephone | 909-331-8046
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 060783
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License Number State | NY
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