Jee Hyun Lyu, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D13892 Issued in MN

Practice address

13875 Hwy 13, Frontage Rd
Suite 50
Savage, MN 55378

Phone

(952) 226-7940

NPI assigned

Aug 20, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Diana Lyu Other name

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Midwest Oral & Maxillofacial Surgery PA

  • Oral and Maxillofacial Surgery (Dentist)
  • Savage, MN
  • NPI 1003983701
  NPD (past)

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

{
    "created_epoch": "1345420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667779200000",
    "number": "1538417795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13875 HWY 13, FRONTAGE RD",
            "address_2": "SUITE 50",
            "city": "SAVAGE",
            "state": "MN",
            "postal_code": "55378",
            "telephone_number": "952-226-7940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13875 HWY 13, FRONTAGE RD",
            "address_2": "SUITE 50",
            "city": "SAVAGE",
            "state": "MN",
            "postal_code": "55378",
            "telephone_number": "952-226-7940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LYU",
        "first_name": "JEE HYUN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-20",
        "last_updated": "2022-11-07",
        "certification_date": "2022-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "RES.3257",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MN",
            "license": "R570",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MN",
            "license": "D13892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DIANA",
            "last_name": "LYU",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Medhat Mohamed Mahmoud Hussein, D.D.S
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• Kristin Eileen Mains, LICSW
• Christina J Manders, D.O.
• Ravi Kiran Mara, DDS

• Oral and Maxillofacial Surgery (Dentist) in Savage, MN
• Providers in Savage, MN by specialty
• Oral and Maxillofacial Surgery (Dentist) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.