Jacob K. Lee, D.D.S.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

38710 Issued in CA

Practice address

903 Calle Amanecer Ste 160
San Clemente, CA 92673-6272

Phone

(949) 361-2838

Fax

(949) 361-2838

NPI assigned

Jan 22, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jacob K Lee, DDS, a Professional Corporation

  • Pediatric Dentistry
  • Rancho Mission Viejo, CA
  • NPI 1033942677
  NPD Authorized official
• Pediatric Dentistry of San Clemente

  • Dental Clinic/Center
  • San Clemente, CA
  • NPI 1902687346
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1083768725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "903 CALLE AMANECER STE 160",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926736272",
            "telephone_number": "949-361-2838",
            "fax_number": "949-361-2838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "903 CALLE AMANECER STE 160",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926736272",
            "telephone_number": "949-361-2838",
            "fax_number": "949-361-2838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "JACOB",
        "middle_name": "K.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "38710",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEID",
            "identifier": "330880247",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberley Anne Lee-Thorp
• Aaron Lee
• Crystal J Lee, DDS
• Frederick Y Lee, DDS
• Heaven Lee
• Samuel Sung-Jae Lee, D.D.S., M.S.
• Bryan Leigh, M.D.
• Nicole Lynn Leland, DC
• Drew Matthew Lemay, PT
• Lydia Lemiesz

• Pediatric Dentistry in San Clemente, CA
• Providers in San Clemente, CA by specialty
• Pediatric Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.