Active NPI
Su Yim Lee, D.D.S.
- General Practice Dentistry
- Sacramento, CA
National Provider Identifier
1689725004
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 54277
- Practice address
- 4801 Freeport Blvd
Sacramento, CA 95822-2101 - Phone
- (916) 456-1013
- Fax
- (916) 456-1932
- NPI assigned
- Jan 13, 2007
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 54277 | CA | Primary |
Addresses
Primary practice location
4801 Freeport Blvd
Sacramento, CA 95822-2101
Mailing address
4801 Freeport Blvd
Sacramento, CA 95822-2101
Phone (916) 456-1013
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168646400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1689725004",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4801 FREEPORT BLVD",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958222101",
"telephone_number": "916-456-1013",
"fax_number": "916-456-1932"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4801 FREEPORT BLVD",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958222101",
"telephone_number": "916-456-1013",
"fax_number": "916-456-1932"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "SU YIM",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "54277",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.