Individual provider Active NPI

Paul J Lee, D.D.S.

  • General Practice Dentistry
  • Hawthorne, CA
National Provider Identifier
1114146784
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
50773 Issued in CA
Practice address
13450 Hawthorne Blvd
Hawthorne, CA 90250-5806
Phone
(310) 679-0106
Fax
(310) 679-6698
NPI assigned
Apr 24, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 50773 CA Primary

Addresses

Primary practice location

13450 Hawthorne Blvd
Hawthorne, CA 90250-5806

Mailing address

13450 Hawthorne Blvd
Hawthorne, CA 90250-5806
Phone (310) 679-0106

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180301001197 CA Order and Referring Only - DentistPractitioner - Dentist 1052672342

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
50773CAMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1114146784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13450 HAWTHORNE BLVD",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902505806",
            "telephone_number": "310-679-0106",
            "fax_number": "310-679-6698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13450 HAWTHORNE BLVD",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902505806",
            "telephone_number": "310-679-0106",
            "fax_number": "310-679-6698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "PAUL",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "50773",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hawthorne, CA

Sources for this page

Verify at the official NPI Registry.