Active NPI
Jung Jun Lee, DMD
- Dentist
- Saint Paul, MN
National Provider Identifier
1053011866
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D15185
- Practice address
- 393 Dunlap St N Ste 308
Saint Paul, MN 55104-4223 - Phone
- (651) 493-1345
- NPI assigned
- Mar 9, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Dentist | 122300000X | D15185 | MN | Primary |
Addresses
Primary practice location
393 Dunlap St N Ste 308
Saint Paul, MN 55104-4223
Mailing address
1959 NE Pacific Street; Box 357134
Seattle, WA 98195
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260515001870 | MN | Practitioner - Dentist | 8123597424 |
Care Compare profile
Medicare Care Compare- Specialty
- Dentist
- Education
- Other, 2023
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
2001 Bloomington Ave
Minneapolis, MN 55404-3089
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D15185 | MN | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1678320000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1725753600000",
"number": "1053011866",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1959 NE PACIFIC STREET; BOX 357134",
"city": "SEATTLE",
"state": "WA",
"postal_code": "98195"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "393 DUNLAP ST N STE 308",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551044223",
"telephone_number": "651-493-1345"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "JUNG JUN",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-03-09",
"last_updated": "2024-09-08",
"certification_date": "2024-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "D15185",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.