MEDICARE: JOON S. LEE DDS PC

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	050790	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578715629
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOON S. LEE DDS PC

Provider Business Mailing Address
First Line	:	503 S BROADWAY STE 250
Second Line	:
City	:	YONKERS
State	:	NY
Zip	:	10705-6202
Country	:	US
Telephone Number	:	914-376-4033
Fax Number	:	914-376-4035

Provider Business Practice Location Address
First Line	:	503 S BROADWAY STE 250
Second Line	:
City	:	YONKERS
State	:	NY
Zip	:	10705-6202
Country	:	US
Telephone Number	:	914-376-4033
Fax Number	:	914-376-4035

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOON S. LEE
Credential	:	DDS
Telephone Number	:	914-376-4033

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	10/21/2008

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