MEDICARE: JAKE J LEE DDS

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
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1396629671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAKE J LEE DDS

Provider Business Mailing Address
First Line	:	830 OBRIEN PL
Second Line	:
City	:	DANVILLE
State	:	CA
Zip	:	94526-1989
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1807 BAY RD
Second Line	:
City	:	EAST PALO ALTO
State	:	CA
Zip	:	94303-1312
Country	:	US
Telephone Number	:	650-289-7710
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2025
Last Update Date	:	03/23/2026

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