Active NPI
Kwang-Lim Lee, DDS
- Dentist
- East Peoria, IL
National Provider Identifier
1942926068
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019.033979
- Practice address
- 502 Riverside Dr
East Peoria, IL 61611-2068 - Phone
- (309) 606-5008
- NPI assigned
- Oct 19, 2022
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 019.033979 | IL | Primary |
Addresses
Primary practice location
502 Riverside Dr
East Peoria, IL 61611-2068
Mailing address
5250 N Knoxville Ave Apt 117
Peoria, IL 61614-5024
Phone (917) 349-6012
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 |
|---|---|---|---|
| 019.033979 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1666137600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1666137600000",
"number": "1942926068",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5250 N KNOXVILLE AVE APT 117",
"city": "PEORIA",
"state": "IL",
"postal_code": "616145024",
"telephone_number": "917-349-6012"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "502 RIVERSIDE DR",
"city": "EAST PEORIA",
"state": "IL",
"postal_code": "616112068",
"telephone_number": "309-606-5008"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "KWANG-LIM",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-10-19",
"last_updated": "2022-10-19",
"certification_date": "2022-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019.033979",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.