Healthcare Provider Details

I. General information

NPI: 1669435681
Provider Name (Legal Business Name): IAN-JAY R. LEE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 PICACHO RD
WINTERHAVEN CA
92283-9605
US

IV. Provider business mailing address

P.O. BOX 62544
IRVINE CA
92602-2544
US

V. Phone/Fax

Practice location:
  • Phone: 760-572-4233
  • Fax:
Mailing address:
  • Phone: 425-210-2305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number49925
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: