NPIMap

Individual provider Active NPI

Joshua Pyunghoon Lee

  • Dentist
  • Malden, MA
National Provider Identifier
1770839367
Registry record updated Nov 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN1856823 Issued in MA
Practice address
389 Main St
Suite 204
Malden, MA 02148-5017
Phone
(781) 322-0888
NPI assigned
Aug 1, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 15108 MD
Dentist 122300000X DN1856823 MA Primary

Addresses

Primary practice location

389 Main St
Suite 204
Malden, MA 02148-5017

Mailing address

210 Winthrop Rd
Apt 12a
Brookline, MA 02445-4424
Phone (443) 538-4129

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

LicenseStateTypeSpecialty
DN1856823MAMDDentist
15108MDMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
209 Brookline Dental Past Accepting new patients
Malden Dental Associates, Inc. Dentist PastSince Dec 11, 2021 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.

NPI Registry JSON

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

{
    "created_epoch": "1343779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447804800000",
    "number": "1770839367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 WINTHROP RD",
            "address_2": "APT 12A",
            "city": "BROOKLINE",
            "state": "MA",
            "postal_code": "024454424",
            "telephone_number": "443-538-4129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "389 MAIN ST",
            "address_2": "SUITE 204",
            "city": "MALDEN",
            "state": "MA",
            "postal_code": "021485017",
            "telephone_number": "781-322-0888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "JOSHUA",
        "middle_name": "PYUNGHOON",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-08-01",
        "last_updated": "2015-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MD",
            "license": "15108",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "DN1856823",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Malden, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2015; 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.