Kyle Kyoungroh Lee

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

14130 Issued in CT

Practice address

199 Main St
Deep River, CT 06417-2021

Phone

(860) 526-9519

NPI assigned

Mar 6, 2023

Last updated

Sep 13, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Deep River Family Dental PLLC

  • General Practice Dentistry
  • Deep River, CT
  • NPI 1548002496
  NPD
• Brilliant Smile Dental, P.C.

  • General Practice Dentistry
  • Meriden, CT
  • NPI 1912364860
  NPD (past)

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

{
    "created_epoch": "1678060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726185600000",
    "number": "1639879943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "199 MAIN ST",
            "city": "DEEP RIVER",
            "state": "CT",
            "postal_code": "064172021",
            "telephone_number": "860-526-9519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "199 MAIN ST",
            "city": "DEEP RIVER",
            "state": "CT",
            "postal_code": "064172021",
            "telephone_number": "860-526-9519"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "725 E Main St",
            "address_purpose": "LOCATION",
            "city": "Meriden",
            "state": "CT",
            "postal_code": "064506005",
            "country_code": "US",
            "telephone_number": "203-235-4930",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEE",
        "first_name": "KYLE",
        "middle_name": "KYOUNGROH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-03-06",
        "last_updated": "2024-09-13",
        "certification_date": "2024-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "14130",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sandra Anne Ely, APRN
• Susan C. Fratoni, RPH
• Daniel Hayes
• Tara Hubbard, PHARMD
• Kathy M Kalista, RPH
• Patrick Liddle, LPC
• Lower Valley Psychotherapy Services LLC
• Robert George Madden, LCSW
• Susan E Mosca, MS,CCC-SLP
• Meredith Newman, MFT

• General Practice Dentistry in Deep River, CT
• Providers in Deep River, CT by specialty
• General Practice Dentistry in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.