Jiyoung Elizabeth Lee, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

D8776 Issued in OR

Practice address

831 NW Council Dr Ste 210
Gresham, OR 97030-3724

Phone

(503) 666-9436

Fax

(503) 912-0757

NPI assigned

Jul 28, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jiyoung E Lee DMD PC

  • Pediatric Dentistry
  • Gresham, OR
  • NPI 1942573118
  NPD Authorized official
• Lee Practice II

  • Dental Clinic/Center
  • Portland, OR
  • NPI 1962809863
  NPD (past) Authorized official

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592179200000",
    "number": "1477567154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "831 NW COUNCIL DR STE 210",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970303724",
            "telephone_number": "503-666-9436",
            "fax_number": "503-912-0757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "831 NW COUNCIL DR STE 210",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970303724",
            "telephone_number": "503-666-9436",
            "fax_number": "503-912-0757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "JIYOUNG",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-28",
        "last_updated": "2020-06-15",
        "certification_date": "2020-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MA",
            "license": "20808",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "OR",
            "license": "D8776",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OMAP",
            "identifier": "028475",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathleen Suzanne Leavitt, M.ED.
• Korina Leclerc, LCSW
• Anna Lee, PAC
• Danielle Cherie Lee, LE
• Haki K Lee, FNP-C
• Marcella Lee
• Legacy Mount Hood Medical Center
• Legacy Mount Hood Medical Center
• Legacy Mount Hood Medical Center
• Legacy Mount Hood Medical Center

• Pediatric Dentistry in Gresham, OR
• Providers in Gresham, OR by specialty
• Pediatric Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2020; 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.