Chang Joo Lee, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

05134 Issued in NH

Practice address

4 Manchester Ave
Derry, NH 03038-1931

Phone

(603) 434-1586

NPI assigned

Jun 15, 2018

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1529020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726099200000",
    "number": "1386138170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 MANCHESTER AVE",
            "city": "DERRY",
            "state": "NH",
            "postal_code": "030381931",
            "telephone_number": "603-434-1586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 MANCHESTER AVE",
            "city": "DERRY",
            "state": "NH",
            "postal_code": "030381931",
            "telephone_number": "603-434-1586"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Kneeland St",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021111527",
            "country_code": "US",
            "telephone_number": "617-636-6971",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEE",
        "first_name": "CHANG JOO",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-06-15",
        "last_updated": "2024-09-12",
        "certification_date": "2024-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "DN1859075",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "34251",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NH",
            "license": "05134",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bethany Lynne Layne, DPT
• Da H Le, MD
• Charlene Evette Leader
• Lisi Leccese
• Bit NA Lee, DMD
• Michael Lee
• Catherine Marie Lehan, NP
• Alexander Lemay
• Andrea Joy Lemire St.Onge, ATC
• Nicole Leo, OD

• Pediatric Dentistry in Derry, NH
• Providers in Derry, NH by specialty
• Pediatric Dentistry in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.