Active NPI
Jae Eun Lee, DDS
- Dentist
- North Bend, OR
National Provider Identifier
1366771875
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D9736
- Practice address
- 1860 Virginia Ave
#8
North Bend, OR 97459-2355 - Phone
- (541) 756-7568
- Fax
- (541) 756-0760
- NPI assigned
- Dec 11, 2009
- Last updated
- Aug 3, 2012
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 60744 | KS | |
| Dentist | 122300000X | D9736 | OR | Primary |
Addresses
Primary practice location
1860 Virginia Ave
#8
North Bend, OR 97459-2355
Mailing address
1860 Virginia Ave
#8
North Bend, OR 97459-2355
Phone (541) 756-7568
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 |
|---|---|---|---|
| 60744 | KS | MD | Dentist |
| D9736 | OR | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Devin M Brice DMD PC | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1260489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1343952000000",
"number": "1366771875",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1860 VIRGINIA AVE",
"address_2": "#8",
"city": "NORTH BEND",
"state": "OR",
"postal_code": "974592355",
"telephone_number": "541-756-7568",
"fax_number": "541-756-0760"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1860 VIRGINIA AVE",
"address_2": "#8",
"city": "NORTH BEND",
"state": "OR",
"postal_code": "974592355",
"telephone_number": "541-756-7568",
"fax_number": "541-756-0760"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "JAE EUN",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-12-11",
"last_updated": "2012-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "KS",
"license": "60744",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OR",
"license": "D9736",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Bend, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.