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NPI Code Detail

MEDICARE: JAY LEE DDS, MD

MEDICARE: JAY LEE DDS, MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208600000XSurgery Physician149022CA
21223S0112XOral and Maxillofacial Surgery (Dentist)101264CA

General Provider Information

NPI Number : 1134418304
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAY LEE DDS, MD
Provider Business Mailing Address
First Line : 2080 CENTURY PARK EAST SUITE 610
Second Line :
City : LOS ANGELES
State : CA
Zip : 90035
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2080 CENTURY PARK E STE 610
Second Line :
City : LOS ANGELES
State : CA
Zip : 90067-2009
Country : US
Telephone Number : 310-842-4811
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2011
Last Update Date : 07/12/2017

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