Provider Demographics
NPI:1316306921
Name:LEE, YUN-YOUNG (DMD)
Entity type:Individual
Prefix:
First Name:YUN-YOUNG
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 THOMAS BURGIN PKWY
Mailing Address - Street 2:APT 456
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-7648
Mailing Address - Country:US
Mailing Address - Phone:617-943-9457
Mailing Address - Fax:
Practice Address - Street 1:953 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02170-3847
Practice Address - Country:US
Practice Address - Phone:617-328-1726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1857280122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HB653348OtherPASSPORT (CANADA)