Active NPI
Marisa Mei Lin Lee, D.M.D.
- Dentist
- Vista, CA
National Provider Identifier
1104194893
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 60938
- Practice address
- 1000 Vale Terrace Dr
Vista, CA 92084-5218 - Phone
- (808) 232-3646
- NPI assigned
- Dec 8, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 60938 | CA | Primary |
| Public Health Dentistry | 1223D0001X | 60938 | CA |
Addresses
Primary practice location
1000 Vale Terrace Dr
Vista, CA 92084-5218
Mailing address
PO Box 9903
San Diego, CA 92169-0903
Phone (808) 232-3646
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120517000535 | CA | Order and Referring Only - Oral Surgery | 1052574647 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1323302400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323302400000",
"number": "1104194893",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 9903",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921690903",
"telephone_number": "808-232-3646"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 VALE TERRACE DR",
"city": "VISTA",
"state": "CA",
"postal_code": "920845218",
"telephone_number": "808-232-3646"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "MARISA",
"middle_name": "MEI LIN",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-12-08",
"last_updated": "2011-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "60938",
"primary": true
},
{
"code": "1223D0001X",
"taxonomy_group": "",
"desc": "Dentist, Dental Public Health",
"state": "CA",
"license": "60938",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vista, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.