Active NPI
Minh Kevin Lee, DDS
- Dentist
- Fairbanks, AK
National Provider Identifier
1417985201
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 20678
- Practice address
- 122 1St Ave
Suite 600
Fairbanks, AK 99701-4803 - Phone
- (907) 452-8251
- Fax
- (907) 459-3837
- NPI assigned
- Jun 29, 2006
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 20678 | TX | Primary |
Addresses
Primary practice location
122 1St Ave
Suite 600
Fairbanks, AK 99701-4803
Mailing address
122 1St Ave
Suite 600
Fairbanks, AK 99701-4803
Phone (907) 452-8251
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 958209 | Medicaid | AZ | |
| 22775528 | Medicaid | NM |
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 |
|---|---|---|---|
| 20678 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151539200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1188345600000",
"number": "1417985201",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "122 1ST AVE",
"address_2": "SUITE 600",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997014803",
"telephone_number": "907-452-8251",
"fax_number": "907-459-3837"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "122 1ST AVE",
"address_2": "SUITE 600",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997014803",
"telephone_number": "907-452-8251",
"fax_number": "907-459-3837"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "MINH",
"middle_name": "KEVIN",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-29",
"last_updated": "2007-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "20678",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "958209",
"state": "AZ"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "22775528",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairbanks, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 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.