Active NPI
Jongin Lee, DDS
- General Practice Dentistry
- Garden Grove, CA
National Provider Identifier
1700039872
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 54172
- Practice address
- 9636 Garden Grove Blvd Ste 3
Garden Grove, CA 92844-1590 - Phone
- (714) 590-2828
- Fax
- (714) 590-2848
- NPI assigned
- Nov 3, 2008
- Sex
- Male
- 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 | 54172 | CA | Primary |
Addresses
Primary practice location
9636 Garden Grove Blvd Ste 3
Garden Grove, CA 92844-1590
Mailing address
9636 Garden Grove Blvd Ste 3
Garden Grove, CA 92844-1590
Phone (714) 590-2828
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 |
|---|---|---|---|
| 54172 | CA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| J&Y Dental Group Inc | General Practice | Current | Accepting new patients |
| 4Udental Group Partners | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- General Practice Dentistry
- Orange, CA
- NPI 1821845041
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1225670400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1225670400000",
"number": "1700039872",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9636 GARDEN GROVE BLVD STE 3",
"city": "GARDEN GROVE",
"state": "CA",
"postal_code": "928441590",
"telephone_number": "714-590-2828",
"fax_number": "714-590-2848"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9636 GARDEN GROVE BLVD STE 3",
"city": "GARDEN GROVE",
"state": "CA",
"postal_code": "928441590",
"telephone_number": "714-590-2828",
"fax_number": "714-590-2848"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "JONGIN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-11-03",
"last_updated": "2008-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "54172",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Garden Grove, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.