MEDICARE: DR. LEE JAY HARRIS 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	1223G0001X	General Practice Dentistry	39005	CA

General Provider Information

NPI Number	:	1992844716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEE JAY HARRIS DDS

Provider Business Mailing Address
First Line	:	3700 WILSHIRE BLVD
Second Line	:	#780
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2901
Country	:	US
Telephone Number	:	213-380-7900
Fax Number	:	213-382-3454

Provider Business Practice Location Address
First Line	:	3700 WILSHIRE BLVD
Second Line	:	#780
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2901
Country	:	US
Telephone Number	:	213-380-7900
Fax Number	:	213-382-3454

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

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	08/22/2008

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