Active NPI
Jaerim Lee, DDS
- Dentist
- Enfield, CT
National Provider Identifier
1508544602
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 13890
- Practice address
- 25 Hazard Ave
Enfield, CT 06082 - Phone
- (845) 372-3603
- NPI assigned
- Jul 10, 2023
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Dentist | 122300000X | 13890 | CT | Primary |
Addresses
Primary practice location
25 Hazard Ave
Enfield, CT 06082
Mailing address
25 Hazard Avenue
Enfield, CT 06082
Phone (845) 372-3692
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 |
|---|---|---|---|
| 13890 | CT | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1688947200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692748800000",
"number": "1508544602",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25 HAZARD AVENUE",
"city": "ENFIELD",
"state": "CT",
"postal_code": "06082",
"telephone_number": "845-372-3692"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25 HAZARD AVE",
"city": "ENFIELD",
"state": "CT",
"postal_code": "06082",
"telephone_number": "845-372-3603"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "JAERIM",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-07-10",
"last_updated": "2023-08-23",
"certification_date": "2023-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CT",
"license": "13890",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Enfield, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.