Active NPI
Daniel Deokchun Lee
- Dentist
- Bloomfield, NJ
National Provider Identifier
1508539503
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 22DI02852700
- Practice address
- 1455 Broad St Ste 105
Bloomfield, NJ 07003-3039 - Phone
- (862) 702-5234
- NPI assigned
- Jul 27, 2021
- 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 | 22DI02852700 | NJ | Primary |
Addresses
Primary practice location
1455 Broad St Ste 105
Bloomfield, NJ 07003-3039
Mailing address
414 Hackensack Ave Apt 1315
Hackensack, NJ 07601-6579
Phone (929) 367-1257
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 |
|---|---|---|---|
| 22DI02852700 | NJ | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1627344000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1627344000000",
"number": "1508539503",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "414 HACKENSACK AVE APT 1315",
"city": "HACKENSACK",
"state": "NJ",
"postal_code": "076016579",
"telephone_number": "929-367-1257"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1455 BROAD ST STE 105",
"city": "BLOOMFIELD",
"state": "NJ",
"postal_code": "070033039",
"telephone_number": "862-702-5234"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "DANIEL",
"middle_name": "DEOKCHUN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-07-27",
"last_updated": "2021-07-27",
"certification_date": "2021-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NJ",
"license": "22DI02852700",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomfield, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.