MEDICARE: JUNG AH LEE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN1856719	MA

General Provider Information

NPI Number	:	1053713396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUNG AH LEE

Provider Business Mailing Address
First Line	:	59 BAY STATE RD APT 3
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02215-1805
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	59 BAY STATE RD APT 3
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02215-1805
Country	:	US
Telephone Number	:	413-320-1343
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2014
Last Update Date	:	09/18/2014

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Directions to “ JUNG AH LEE ” Practice Location

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