Healthcare Provider Details

I. General information

NPI: 1699687418
Provider Name (Legal Business Name): JASON LAI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 VETERAN AVE APT 240
LOS ANGELES CA
90024-4825
US

IV. Provider business mailing address

1440 VETERAN AVE APT 240
LOS ANGELES CA
90024-4825
US

V. Phone/Fax

Practice location:
  • Phone: 650-804-5399
  • Fax:
Mailing address:
  • Phone: 650-804-5399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS112866
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: