Individual provider Active NPI

Jae Yong Lee, DMD PHD

  • Dentist
  • Louisville, KY
National Provider Identifier
1285263012
Registry record updated Apr 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
10520 Issued in KY
Practice address
5014B Preston Hwy
Louisville, KY 40213-2217
Phone
(502) 966-0188
NPI assigned
Apr 3, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 1, 2026

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 0401417153 VA
Dentist 122300000X 12013758A IN
Dentist 122300000X 30.027201 OH
Dentist 122300000X 10520 KY Primary
Dentist 122300000X 11405 TN
Dentist 122300000X 105652 CA

Addresses

Primary practice location

5014B Preston Hwy
Louisville, KY 40213-2217

Mailing address

5014B Preston Hwy
Louisville, KY 40213-2217

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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

Enrollment IDStateProvider typePAC IDDetails
I20201209003076 KY Order and Referring Only - DentistPractitioner - Dentist 2062824337

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
105652CAMDDentist
12013758AINMDDentist
30.027201OHMDDentist
0401417153VAMDDentist
11405TNMDPharmacotherapy Pharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
My Smile Dental Services, PLLC Dentist PastSince Aug 2, 2020 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.

NPI Registry JSON

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

{
    "created_epoch": "1585872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775001600000",
    "number": "1285263012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5014B PRESTON HWY",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402132217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5014B PRESTON HWY",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402132217",
            "telephone_number": "502-966-0188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "JAE",
        "middle_name": "YONG",
        "name_prefix": "Dr.",
        "credential": "DMD PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-04-03",
        "last_updated": "2026-04-01",
        "certification_date": "2026-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401417153",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12013758A",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "30.027201",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KY",
            "license": "10520",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TN",
            "license": "11405",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "105652",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.