MEDICARE: JAE HOON LEE DDS

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	1223G0001X	General Practice Dentistry	42506	TX

General Provider Information

NPI Number	:	1285550053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAE HOON LEE DDS

Provider Business Mailing Address
First Line	:	PO BOX 660682
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75266-0682
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5334A ROSS AVE STE 800
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-7419
Country	:	US
Telephone Number	:	469-490-3709
Fax Number	:

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

Provider Enumeration Date	:	06/26/2026
Last Update Date	:	07/02/2026

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