Individual provider Active NPI

Sungwhan Lee, DDS

  • General Practice Dentistry
  • Corte Madera, CA
National Provider Identifier
1164200754
Registry record updated Aug 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
113358 Issued in CA
Practice address
101 Nellen Ave FL 1
Corte Madera, CA 94925-1148
Phone
(415) 718-0303
NPI assigned
Sep 15, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 113358 CA Primary

Addresses

Primary practice location

101 Nellen Ave FL 1
Corte Madera, CA 94925-1148

Mailing address

101 Nellen Ave FL 1
Corte Madera, CA 94925-1148
Phone (415) 718-0303

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DT-3132-0HIMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1694736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788048000000",
    "number": "1164200754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 NELLEN AVE FL 1",
            "city": "CORTE MADERA",
            "state": "CA",
            "postal_code": "949251148",
            "telephone_number": "415-718-0303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 NELLEN AVE FL 1",
            "city": "CORTE MADERA",
            "state": "CA",
            "postal_code": "949251148",
            "telephone_number": "415-718-0303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "SUNGWHAN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-09-15",
        "last_updated": "2026-08-30",
        "certification_date": "2026-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "113358",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Corte Madera, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.