Eun Jin Lee, D.D.S

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019029033 Issued in IL

Practice address

3115 Williamson County Pkwy
Marion, IL 62959-5235

Phone

(618) 969-8600

Fax

(618) 997-8978

NPI assigned

Jun 9, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1339200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1422921600000",
    "number": "1932461639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 CALIFORNIA ST",
            "address_2": "PO BOX 577",
            "city": "CARTERVILLE",
            "state": "IL",
            "postal_code": "629181923",
            "telephone_number": "618-985-8221",
            "fax_number": "618-985-4635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3115 WILLIAMSON COUNTY PKWY",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629595235",
            "telephone_number": "618-969-8600",
            "fax_number": "618-997-8978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "EUN JIN",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-09",
        "last_updated": "2015-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019029033",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019029033",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James T Lawler, M.D.
• Michael Patrick Lawler, MD
• Cari Layman-Yates
• Lori Ann Ledbetter
• Ashton Lee, PA
• Carolyn Marie Legare, AUD
• Dawn Leming, AA
• Mary Robin Lenard-Ziegler
• Tammy Renae Lence
• Jessica Lenon

• General Practice Dentistry in Marion, IL
• Providers in Marion, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 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.