Active NPI
Eugenia Lee, D.M.D., M.S.D.
- Orthodontics and Dentofacial Orthopedics Dentistry
- Kenmore, WA
National Provider Identifier
1629455209
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- DE60022546
- Practice address
- 18115 68TH Ave NE Ste C104
Kenmore, WA 98028-3010 - Phone
- (485) 486-5033
- Fax
- (425) 402-3788
- NPI assigned
- May 2, 2015
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | DE60022546 | WA | Primary |
Addresses
Primary practice location
18115 68TH Ave NE Ste C104
Kenmore, WA 98028-3010
Mailing address
18115 68TH Ave NE Ste C104
Kenmore, WA 98028-3010
Phone (485) 486-5033
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 |
|---|---|---|---|
| DE60022546 | WA | MD | Orthodontics and Dentofacial Orthopedic Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Edward Im DDS PS | Orthodontics and Dentofacial Orthopedics | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1430524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1682640000000",
"number": "1629455209",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18115 68TH AVE NE STE C104",
"city": "KENMORE",
"state": "WA",
"postal_code": "980283010",
"telephone_number": "485-486-5033",
"fax_number": "425-402-3788"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18115 68TH AVE NE STE C104",
"city": "KENMORE",
"state": "WA",
"postal_code": "980283010",
"telephone_number": "485-486-5033",
"fax_number": "425-402-3788"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "EUGENIA",
"credential": "D.M.D., M.S.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-05-02",
"last_updated": "2023-04-28",
"certification_date": "2023-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "WA",
"license": "DE60022546",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kenmore, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 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.