Active NPI
Eunkyoung Diane E Lee, D.D.S
- Dentist
- Benton Harbor, MI
National Provider Identifier
1356493019
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 018844
- Practice address
- 143 E Main St
Benton Harbor, MI 49022-4409 - Phone
- (269) 927-1313
- Fax
- (269) 934-9447
- NPI assigned
- Jan 16, 2007
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 018844 | MI | Primary |
Addresses
Primary practice location
143 E Main St
Benton Harbor, MI 49022-4409
Mailing address
143 E Main St
Benton Harbor, MI 49022-4409
Phone (269) 927-1313
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 |
|---|---|---|---|
| 018844 | MI | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pokagon Band of Potawatomi Indians | Past | Accepting new patients | |
| Harbor Dental | Dentist | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Dentist
- Benton Harbor, MI
- NPI 1992712061
-
- Federally Qualified Health Center (FQHC)
- Dowagiac, MI
- NPI 1497833271
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1202947200000",
"number": "1356493019",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "143 E MAIN ST",
"city": "BENTON HARBOR",
"state": "MI",
"postal_code": "490224409",
"telephone_number": "269-927-1313",
"fax_number": "269-934-9447"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "143 E MAIN ST",
"city": "BENTON HARBOR",
"state": "MI",
"postal_code": "490224409",
"telephone_number": "269-927-1313",
"fax_number": "269-934-9447"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "EUNKYOUNG DIANE",
"middle_name": "E",
"credential": "D.D.S",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-16",
"last_updated": "2008-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "018844",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Benton Harbor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.