MEDICARE: DR. KATHERINE KYOUNG-JIN LEE D.D.S.

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	P71274	NY

General Provider Information

NPI Number	:	1689804569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHERINE KYOUNG-JIN LEE D.D.S.

Provider Business Mailing Address
First Line	:	1210 LAKEWOOD PL
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-1816
Country	:	US
Telephone Number	:	917-334-0636
Fax Number	:

Provider Business Practice Location Address
First Line	:	1210 LAKEWOOD PL
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-1816
Country	:	US
Telephone Number	:	917-334-0636
Fax Number	:

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

Provider Enumeration Date	:	07/25/2009
Last Update Date	:	07/25/2009

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