Jiyoung E Lee DMD PC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

D8776 Issued in OR

Legal business name

JIYOUNG E LEE DMD PC

Practice address

831 NW Council Dr Ste 210
Gresham, OR 97030-3724

Phone

(503) 666-9436

NPI assigned

Feb 17, 2012

Organization subpart

No

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

Authorized official

Name

Jiyoung Lee, DMDNPI 1477567154

Title

Owner

Phone

(503) 666-9436

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Gresham Pediatric Dentistry Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jiyoung Elizabeth Lee, DMD

  • Pediatric Dentistry
  • Gresham, OR
  • NPI 1477567154
  NPD Authorized official
• John H Frick DMD PC, DMD

  • Pediatric Dentistry
  • Gresham, OR
  • NPI 1215926720
  NPD (past)

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

{
    "created_epoch": "1329436800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592870400000",
    "number": "1942573118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "831 NW COUNCIL DR",
            "address_2": "STE 210",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970303721",
            "telephone_number": "503-761-2243",
            "fax_number": "503-761-1540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "831 NW COUNCIL DR STE 210",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970303724",
            "telephone_number": "503-666-9436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JIYOUNG E LEE DMD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-17",
        "last_updated": "2020-06-23",
        "certification_date": "2020-06-23",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "JIYOUNG",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-666-9436",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "OR",
            "license": "D8776",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "028475",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gresham Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Gresham Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kathryn Elizabeth Jepsen, RN
• Kayla Jerde, PA-C
• Emilee Nicole Jergensen, DC
• Courtney Monique Jessie, LPC
• Jill Turner ND PC
• Laura Erin Joachim, MA, LPC
• John C. Anderson, M.D., P.C.
• John H Frick DMD PC
• Michelle L John, M.D.
• Johnson Chiropractic Clinic PC

• Pediatric Dentistry in Gresham, OR
• Providers in Gresham, OR by specialty
• Pediatric Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2020; 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.