Active NPI
Jay Lee, DDS, MD
- Oral and Maxillofacial Surgery (Dentist)
- Los Angeles, CA
National Provider Identifier
1134418304
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)
- License
- 101264
- Practice address
- 2080 Century Park E Ste 610
Los Angeles, CA 90067-2009 - Phone
- (310) 842-4811
- NPI assigned
- Mar 28, 2011
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 149022 | CA | |
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 101264 | CA | Primary |
Addresses
Primary practice location
2080 Century Park E Ste 610
Los Angeles, CA 90067-2009
Mailing address
2080 Century Park East Suite 610
Los Angeles, CA 90035
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective May 21, 2024 through May 21, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149022 | CA | MD | Surgery Physician |
Interoperability endpoints
- jlee214412@direct.cshs.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1301270400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1499817600000",
"number": "1134418304",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2080 CENTURY PARK EAST SUITE 610",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90035"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2080 CENTURY PARK E STE 610",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900672009",
"telephone_number": "310-842-4811"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "JAY",
"credential": "DDS, MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-03-28",
"last_updated": "2017-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "CA",
"license": "149022",
"primary": false
},
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "CA",
"license": "101264",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.