Active NPI
Kelly Yun-Kyung Lee, D.M.D
- Periodontics
- New York, NY
National Provider Identifier
1407045784
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 049379
- Practice address
- 241 W 23Rd St
New York, NY 10011-2320 - Phone
- (212) 691-2112
- Fax
- (212) 691-2115
- NPI assigned
- Oct 23, 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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 049379 | NY | Primary |
Addresses
Primary practice location
241 W 23Rd St
New York, NY 10011-2320
Mailing address
18 Wendy LN
East Northport, NY 11731-4814
Phone (917) 488-5903
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 |
|---|---|---|---|
| 049379 | NY | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193097600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193097600000",
"number": "1407045784",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18 WENDY LN",
"city": "EAST NORTHPORT",
"state": "NY",
"postal_code": "117314814",
"telephone_number": "917-488-5903"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "241 W 23RD ST",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100112320",
"telephone_number": "212-691-2112",
"fax_number": "212-691-2115"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "KELLY",
"middle_name": "YUN-KYUNG",
"name_prefix": "Dr.",
"credential": "D.M.D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-10-23",
"last_updated": "2007-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "NY",
"license": "049379",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.