Active NPI
Jaeyoung Lee
- General Practice Dentistry
- Flowery Branch, GA
National Provider Identifier
1376307264
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN123810
- Practice address
- 4690 Hog Mountain Rd Ste H105
Flowery Branch, GA 30542-6422 - Phone
- (770) 967-1001
- NPI assigned
- Feb 12, 2024
- Sex
- Male
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN123810 | GA | Primary |
Addresses
Primary practice location
4690 Hog Mountain Rd Ste H105
Flowery Branch, GA 30542-6422
Mailing address
1290 Old Peachtree Rd Apt 4321
Duluth, GA 30097-5324
Phone (803) 243-7290
Other practice location 1
1630 Pleasant Hill Rd Ste 200
Duluth, GA 30096-5828
Phone (770) 381-7878
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 |
|---|---|---|---|
| DN123810 | GA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1707696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1761782400000",
"number": "1376307264",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1290 OLD PEACHTREE RD APT 4321",
"city": "DULUTH",
"state": "GA",
"postal_code": "300975324",
"telephone_number": "803-243-7290"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4690 HOG MOUNTAIN RD STE H105",
"city": "FLOWERY BRANCH",
"state": "GA",
"postal_code": "305426422",
"telephone_number": "770-967-1001"
}
],
"practiceLocations": [
{
"address_1": "1630 Pleasant Hill Rd Ste 200",
"address_purpose": "LOCATION",
"city": "Duluth",
"state": "GA",
"postal_code": "300965828",
"country_code": "US",
"telephone_number": "770-381-7878",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LEE",
"first_name": "JAEYOUNG",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-02-12",
"last_updated": "2025-10-30",
"certification_date": "2025-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "GA",
"license": "DN123810",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Flowery Branch, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.