Healthcare Provider Details

I. General information

NPI: 1932248085
Provider Name (Legal Business Name): DR JEFFREY LEE MD DMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 08/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17452 IRVINE BLVD SUITE 100
TUSTIN CA
92780-3031
US

IV. Provider business mailing address

17452 IRVINE BLVD SUITE 100
TUSTIN CA
92780-3031
US

V. Phone/Fax

Practice location:
  • Phone: 714-734-9363
  • Fax: 714-734-9362
Mailing address:
  • Phone: 714-734-9363
  • Fax: 714-734-9362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number00008
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberG73560
License Number StateCA

VIII. Authorized Official

Name: DR. JEFFREY LEE
Title or Position: OWNER SURGEON
Credential: MD DMD
Phone: 714-734-9363