Active NPI
Jenna Yeonkyung Lee, DMD
- Pediatric Dentistry
- Kinnelon, NJ
National Provider Identifier
1295356525
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 22DI02964700
- Practice address
- 11 Kiel Ave
Kinnelon, NJ 07405-2549 - Phone
- (973) 838-7888
- NPI assigned
- Apr 28, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | DN1859409 | MA | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Pediatric Dentistry | 1223P0221X | 22DI02964700 | NJ | Primary |
Addresses
Primary practice location
11 Kiel Ave
Kinnelon, NJ 07405-2549
Mailing address
11 Kiel Ave
Kinnelon, NJ 07405-2549
Phone (973) 838-7888
Other practice location 1
230 Maple St
Holyoke, MA 01040-5144
Phone (413) 420-2200
Other practice location 2
413 Broadway Ste B
Methuen, MA 01844-2062
Phone (978) 258-1363
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 |
|---|---|---|---|
| DN1859409 | MA | MD | Pediatric Dentist |
| 22DI02964700 | NJ | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1588032000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1689292800000",
"number": "1295356525",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11 KIEL AVE",
"city": "KINNELON",
"state": "NJ",
"postal_code": "074052549",
"telephone_number": "973-838-7888"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11 KIEL AVE",
"city": "KINNELON",
"state": "NJ",
"postal_code": "074052549",
"telephone_number": "973-838-7888"
}
],
"practiceLocations": [
{
"address_1": "230 Maple St",
"address_purpose": "LOCATION",
"city": "Holyoke",
"state": "MA",
"postal_code": "010405144",
"country_code": "US",
"telephone_number": "413-420-2200",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "413 Broadway Ste B",
"address_purpose": "LOCATION",
"city": "Methuen",
"state": "MA",
"postal_code": "018442062",
"country_code": "US",
"telephone_number": "978-258-1363",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LEE",
"first_name": "JENNA",
"middle_name": "YEONKYUNG",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-04-28",
"last_updated": "2023-07-14",
"certification_date": "2023-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Dentist, Pediatric Dentistry",
"state": "MA",
"license": "DN1859409",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "NJ",
"license": "22DI02964700",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kinnelon, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.