NPIMap

Organization Active NPI

Jin Il T. Lee, D.D.S., a Professional Corporation

  • General Practice Dentistry
  • Ventura, CA
National Provider Identifier
1174744569
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
44206 Issued in CA
Legal business name
JIN IL T. LEE, D.D.S., A PROFESSIONAL CORPORATION
Practice address
1752 S Victoria Ave
Suite 200
Ventura, CA 93003-6192
Phone
(805) 644-0600
Fax
(805) 644-0611
NPI assigned
May 1, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Jin Il Taek Lee, D.D.S.NPI 1770933525
Title
Owner
Phone
(805) 644-0600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 44206 CA Primary

Addresses

Primary practice location

1752 S Victoria Ave
Suite 200
Ventura, CA 93003-6192

Mailing address

1752 S Victoria Ave
Suite 200
Ventura, CA 93003-6192
Phone (805) 644-0600

National Provider Directory

National Provider Directory

Locations

1752 S Victoria Ave
Ste 200
Ventura, CA 93003
Phone (805) 644-0600

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1174744569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1752 S VICTORIA AVE",
            "address_2": "SUITE 200",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930036192",
            "telephone_number": "805-644-0600",
            "fax_number": "805-644-0611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1752 S VICTORIA AVE",
            "address_2": "SUITE 200",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930036192",
            "telephone_number": "805-644-0600",
            "fax_number": "805-644-0611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JIN IL T. LEE, D.D.S., A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "JIN IL",
        "authorized_official_middle_name": "TAEK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "805-644-0600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "44206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ventura, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.