# JIYOUNG E LEE DMD PC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Gresham Pediatric Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942573118
- **Authorized official:** JIYOUNG LEE DMD (OWNER)
- **Authorized official phone:** (503) 666-9436

## Contact information

- **Practice address:** 831 NW COUNCIL DR STE 210, GRESHAM, OR 97030-3724
- **Practice address phone:** (503) 666-9436
- **Mailing address:** 831 NW COUNCIL DR, STE 210, GRESHAM, OR 97030-3721
- **Mailing address phone:** (503) 761-2243
- **Mailing address fax:** (503) 761-1540

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | D8776 | OR | Yes |

## Other

- **Enumeration date:** 02/17/2012
- **Last updated:** 06/23/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 028475 | — | OR |