Individual
JAKE LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
320 E 58TH ST APT 7G, NEW YORK, NY 10022-2226
(678) 773-5659
Mailing address
320 E 58TH ST APT 7G, NEW YORK, NY 10022-2226
(678) 773-5659
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
062906
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/20/2021
Last updated
01/10/2024
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