Active NPI
Jensen Jason Lee, DMD
- Dentist
- Milpitas, CA
National Provider Identifier
1194964262
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 34868
- Practice address
- 40 N Park Victoria Dr
#B
Milpitas, CA 95035-4600 - Phone
- (408) 586-9663
- Fax
- (408) 824-5001
- NPI assigned
- Feb 13, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 34868 | CA | Primary |
Addresses
Primary practice location
40 N Park Victoria Dr
#B
Milpitas, CA 95035-4600
Mailing address
40 N Park Victoria Dr
#B
Milpitas, CA 95035-4600
Phone (408) 586-9663
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: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170206001537 | CA | Order and Referring Only - Other (Non-Physician) | 3678856291 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34868 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1234483200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1248220800000",
"number": "1194964262",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "40 N PARK VICTORIA DR",
"address_2": "#B",
"city": "MILPITAS",
"state": "CA",
"postal_code": "950354600",
"telephone_number": "408-586-9663",
"fax_number": "408-824-5001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "40 N PARK VICTORIA DR",
"address_2": "#B",
"city": "MILPITAS",
"state": "CA",
"postal_code": "950354600",
"telephone_number": "408-586-9663",
"fax_number": "408-824-5001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "JENSEN",
"middle_name": "JASON",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-02-13",
"last_updated": "2009-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "34868",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Milpitas, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2009; 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.