Active NPI
Jenna Younyoung Lee, DDS
- General Practice Dentistry
- Fullerton, CA
National Provider Identifier
1356907737
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DDS105870
- Practice address
- 1573 S Harbor Blvd
Fullerton, CA 92832-3402 - Phone
- (714) 441-0131
- NPI assigned
- May 11, 2019
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| General Practice Dentistry | 1223G0001X | DDS105870 | CA | Primary |
Addresses
Primary practice location
1573 S Harbor Blvd
Fullerton, CA 92832-3402
Mailing address
2513 Tiffany PL
Fullerton, CA 92833-1527
Phone (714) 743-5293
Other names 1
- Younyoung Lee
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 |
|---|---|---|---|
| DDS105870 | CA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pham and Sambangi Dental Corporation | 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
- Fullerton, CA
- NPI 1114364395
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1557532800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1611532800000",
"number": "1356907737",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2513 TIFFANY PL",
"city": "FULLERTON",
"state": "CA",
"postal_code": "928331527",
"telephone_number": "714-743-5293"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1573 S HARBOR BLVD",
"city": "FULLERTON",
"state": "CA",
"postal_code": "928323402",
"telephone_number": "714-441-0131"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "JENNA",
"middle_name": "YOUNYOUNG",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-05-11",
"last_updated": "2021-01-25",
"certification_date": "2021-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "DDS105870",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "YOUNYOUNG",
"last_name": "LEE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Fullerton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.