Active NPI
Mary Minyoung Lee, D.M.D.
- General Practice Dentistry
- West Sacramento, CA
National Provider Identifier
1245589936
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 61867
- Practice address
- 2455 Jefferson Blvd Ste 130
West Sacramento, CA 95691-5328 - Phone
- (916) 372-8062
- NPI assigned
- Sep 10, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 61867 | CA | Primary |
Addresses
Primary practice location
2455 Jefferson Blvd Ste 130
West Sacramento, CA 95691-5328
Mailing address
2417 Gunn Rd
Carmichael, CA 95608-5024
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
| License | State | Type | Specialty |
|---|---|---|---|
| 61867 | CA | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dental Corporation of Amardeep Gill DDS | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- West Sacramento, CA
- NPI 1184874026
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1347235200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1437696000000",
"number": "1245589936",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2417 GUNN RD",
"city": "CARMICHAEL",
"state": "CA",
"postal_code": "956085024"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2455 JEFFERSON BLVD STE 130",
"city": "WEST SACRAMENTO",
"state": "CA",
"postal_code": "956915328",
"telephone_number": "916-372-8062"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "MARY",
"middle_name": "MINYOUNG",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-09-10",
"last_updated": "2015-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "61867",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.