Lee, Eun Jin

Lee, Eun Jin is an individual health care provider with primary practice located at 3115 Williamson County Pkwy , Marion IL 62959-5235. She recently has only one registered license in Dental Providers / General Practice, which is considered as her primary health care specialty. Lee, Eun Jin can be contacted via phone (618) 969-8600.

Contact Information

Primary practice address
3115 Williamson County Pkwy Marion IL 62959-5235
Phone: (618) 969-8600
Fax: (618) 997-8978
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 019029033 Illinois

Profile Details

NPI number 1932461639
LBN Legal business name Lee, Eun Jin
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 9th, 2012
Last updated Feb 3rd, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1932461639 NPPES
Illinois MEDICAID 019029033

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