Active NPI
Cheolsoo Lee, DDS
- Dentist
- Independence, MO
National Provider Identifier
1336877539
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2022022940
- Practice address
- 3908 S Noland Rd
Independence, MO 64055-3347 - Phone
- (816) 461-2273
- NPI assigned
- Aug 15, 2022
- Last updated
- Aug 15, 2022
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 2022022940 | MO | Primary |
Addresses
Primary practice location
3908 S Noland Rd
Independence, MO 64055-3347
Mailing address
5314 W 121St Ter Apt 212
Overland Park, KS 66209-3568
Phone (602) 334-9225
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 18, 2023 through Jul 18, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2022022940 | MO | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dental Care Independence | Past | Accepting new patients | |
| Smile Care Raytown, LLC | Dentist | Past | Accepting new patients |
| Raytown Dental LLC | Past | Accepting new patients | |
| Noland Road Dental, LLC | Past | Accepting new patients |
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- General Practice Dentistry
- Independence, MO
- NPI 1407205099
-
- Dental Clinic/Center
- Independence, MO
- NPI 1871730952
-
- Dentist
- Raytown, MO
- NPI 1629511266
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1660521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660521600000",
"number": "1336877539",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5314 W 121ST TER APT 212",
"city": "OVERLAND PARK",
"state": "KS",
"postal_code": "662093568",
"telephone_number": "602-334-9225"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3908 S NOLAND RD",
"city": "INDEPENDENCE",
"state": "MO",
"postal_code": "640553347",
"telephone_number": "816-461-2273"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "CHEOLSOO",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-08-15",
"last_updated": "2022-08-15",
"certification_date": "2022-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MO",
"license": "2022022940",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Independence, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.