Healthcare Provider Details

I. General information

NPI: 1255795597
Provider Name (Legal Business Name): JAY LEE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2071 HERNDON AVE
CLOVIS CA
93611-6101
US

IV. Provider business mailing address

7300 N FRESNO ST
FRESNO CA
93720-2941
US

V. Phone/Fax

Practice location:
  • Phone: 559-324-5100
  • Fax: 806-322-3006
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number271677
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberT1137
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: