Grace Eunah Lee

Primary specialty

DentistTaxonomy code 122300000X

License

63020 Issued in CA

Practice address

11016 Via del Corso
Riverside, CA 92505-2384

Phone

(951) 729-6866

NPI assigned

Nov 13, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Eun-Ah Shin Other name

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1384300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549929600000",
    "number": "1184054058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11016 VIA DEL CORSO",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925052384",
            "telephone_number": "909-528-7824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11016 VIA DEL CORSO",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925052384",
            "telephone_number": "951-729-6866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "GRACE",
        "middle_name": "EUNAH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-13",
        "last_updated": "2019-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "63020",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "EUN-AH",
            "last_name": "SHIN",
            "credential": "D.D.S",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• David Won Lee
• Edward Lee, DO
• Eunjin Lee
• Gary D Lee, DDS
• Gilbert Haegil Lee, M.D.
• Gregory Lee
• Han Som Lee
• Hans C Lee
• Howard H. Lee, DO
• Ivan S. Lee, MD

• Dentist in Riverside, CA
• Providers in Riverside, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.