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SEONGNOH LEE
NPI 1164007092
Dentist - Oral and Maxillofacial Surgery in Hackensack, NJ

Active since March 11, 2021PECOS EnrolledAccepts Medicare Assignment
20 PROSPECT AVE STE 719, HACKENSACK, NJ 07601(551) 996-5002(551) 996-5099 Get Directions Write a Review

NPPES record last updated: March 12, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Mar 12, 2026, Jul 20, 2022, Mar 11, 2021 (3 updates tracked since 2021).

About Seongnoh Lee NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SEONGNOH LEE (NPI 1164007092) is an individual oral and maxillofacial surgery provider in Hackensack, New Jersey, licensed in New Jersey (22DI03073000) and active in the NPI registry since March 2021. He is enrolled in Medicare PECOS, maintains 3 additional practice locations, and is a graduate of University Of Detroit Mercy School Of Dentistry (2021).

NPPES Registry Identity

NPI1164007092
Entity TypeIndividualMale
Primary Taxonomy1223S0112X
Provider Legal NameSEONGNOH LEE
Location Address20 PROSPECT AVE STE 719Hackensack, NJ 07601-1974
Mailing Address1441 N 12th St Fl 3Phoenix, AZ 85006-2837
Phone(551) 996-5002
Fax(551) 996-5099
Sole ProprietorNo
Medical School CMSUniversity Of Detroit Mercy School Of DentistryGraduated 2021
Enumeration DateMarch 11, 2021
Last NPPES UpdateMarch 12, 20263 updates tracked since enumeration
NPPES CertifiedMarch 12, 2026
✔ NPI 1164007092 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers
Taxonomy Code1223S0112X
License✔ Licensed in NJ · 22DI03073000
Definition
An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
20 PROSPECT AVE STE 719, Hackensack, NJ 07601
Open in Google Maps ↗

Secondary Practice Locations 3

Location 1110 Bergen StNewark, NJ 07103-2495 · Phone (973) 972-4242
Location 2102 James St Ste 201Edison, NJ 08820-3970 · Phone (551) 996-5002 · Fax (551) 996-5099
Location 31441 N 12th St Fl 3Phoenix, AZ 85006-2837 · Phone (602) 521-5977

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter Health, Ambetter Health of Delaware, Anthem Blue Cross and Blue Shield and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Seongnoh Lee is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID648652198
PECOS Enrollment IDI20260612001938
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Seongnoh Lee reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Hackensack Meridian Health Medical Group - Specialty Care PC
38 mi
Surgical Critical Care
331 NEWMAN SPRINGS RD STE 220
Red Bank, NJ 07701
  • Reassigned Medicare billing, New Jersey enrollment
  • 2,844 clinicians in this Medicare group
NPI 1215989249 (732) 807-0800

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 07601 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$98.09 typical visit price
range $63.84 – $190.92
Typical copayment $24.52 (range $15.96 – $47.73)
Most-billed visit code 99203
Established Patient
$79.09 typical visit price
range $20.97 – $155.92
Typical copayment $19.77 (range $5.24 – $38.98)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

YITZHACK ASULIN, MD, PC
Specialist
20 PROSPECT AVE STE 719
HACKENSACK, NJ 07601
Bergen County (201) 880-5578
HACKENSACK MERIDIAN HEALTH MEDICAL GROUP - SPECIALTY CARE PC
Durable Medical Equipment & Medical Supplies
20 PROSPECT AVE STE 719
HACKENSACK, NJ 07601
Bergen County (551) 996-5002
HADI A LUTFI DDS
Dentist (Oral and Maxillofacial Surgery)
20 PROSPECT AVE STE 719
HACKENSACK, NJ 07601
Bergen County (551) 996-5002

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Seongnoh Lee's NPI number?

The NPI number for Seongnoh Lee is 1164007092. It was assigned to this individual provider in the NPPES registry on March 11, 2021.

Where is Seongnoh Lee located?

Seongnoh Lee practices at 20 Prospect Ave Ste 719, Hackensack, NJ 07601. The listed phone number is (551) 996-5002.

What is Seongnoh Lee's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Is Seongnoh Lee enrolled in Medicare?

Yes. Seongnoh Lee is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Seongnoh Lee's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Seongnoh Lee reassigns Medicare benefits to Hackensack Meridian Health Medical Group - Specialty Care PC (Red Bank, NJ). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Seongnoh Lee's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Seongnoh Lee accept?

Health plans from Ambetter Health, Ambetter Health of Delaware, Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Montana and Blue Cross and Blue Shield of Oklahoma and 2 other insurers list Seongnoh Lee as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Seongnoh Lee was last updated on March 12, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.