Individual provider Active NPI

SE Rin Lee, DDS, MD

  • Oral & Maxillofacial Surgery (D.M.D.)
  • West Hartford, CT
National Provider Identifier
1629579479
Registry record updated Sep 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X
License
14813 Issued in CT
Practice address
928 Farmington Ave
West Hartford, CT 06107-2227
Phone
(860) 232-4606
NPI assigned
Feb 27, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral & Maxillofacial Surgery (D.M.D.) 204E00000X 14813 CT Primary

Addresses

Primary practice location

928 Farmington Ave
West Hartford, CT 06107-2227

Mailing address

928 Farmington Ave
West Hartford, CT 06107-2227
Phone (860) 232-4606

Other practice location 1

131 New London Tpke Ste 106
Glastonbury, CT 06033-2246
Phone (860) 659-2623

Other practice location 2

483 Middle Tpke W Ste 102
Manchester, CT 06040-3864
Phone (860) 649-2272

Other names 1

  • Serin Lee Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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

Enrollment IDStateProvider typePAC IDDetails
I20180919000414 IL Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 5890046569

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
9613NEMDOral & Maxillofacial Surgery (D.M.D.)

NPI Registry JSON

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

{
    "created_epoch": "1519689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788480000000",
    "number": "1629579479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "928 FARMINGTON AVE",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061072227",
            "telephone_number": "860-232-4606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "928 FARMINGTON AVE",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061072227",
            "telephone_number": "860-232-4606"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "131 New London Tpke Ste 106",
            "address_purpose": "LOCATION",
            "city": "Glastonbury",
            "state": "CT",
            "postal_code": "060332246",
            "country_code": "US",
            "telephone_number": "860-659-2623",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "483 Middle Tpke W Ste 102",
            "address_purpose": "LOCATION",
            "city": "Manchester",
            "state": "CT",
            "postal_code": "060403864",
            "country_code": "US",
            "telephone_number": "860-649-2272",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEE",
        "first_name": "SE RIN",
        "credential": "DDS, MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-27",
        "last_updated": "2026-09-04",
        "certification_date": "2026-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "CT",
            "license": "14813",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SERIN",
            "last_name": "LEE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in West Hartford, CT

Sources for this page

Verify at the official NPI Registry.