Tyler Lee, DMD

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

26302 La Paz Rd Ste 102
Mission Viejo, CA 92691-5327

Phone

(949) 203-0076

NPI assigned

Apr 12, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jul 25, 2022 through Jul 25, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: tlee845055@direct.memorialcare.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cummings, Balasanian, Caputo & Nicholls Dental Group, Inc.

  • Oral and Maxillofacial Surgery (Dentist)
  • Mission Viejo, CA
  • NPI 1700962347
  NPD (past)
• P Grewal DDS Inc

  • Oral and Maxillofacial Surgery (Dentist)
  • Chino Hills, CA
  • NPI 1225903560
  NPD (past)

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

{
    "created_epoch": "1523491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712620800000",
    "number": "1477050755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10998 S MAPLE FOREST WAY",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840954120",
            "telephone_number": "949-533-4413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26302 LA PAZ RD STE 102",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926915327",
            "telephone_number": "949-203-0076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "TYLER",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-12",
        "last_updated": "2024-04-09",
        "certification_date": "2024-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "DDS107439",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rana Lee, PA-C
• Scott S Lee, MD
• Shin Ae Lee
• Sunyoung Lee
• Susan Lee, MS, MDIV
• Hope Marie Lefebvre, CADC - CAS
• Sherine Ann Legge, PHARM.D.
• Jack Robert Leggett Jr., PH.D.
• Leila Ahmadi OD, Apc, an Optometric Corporation
• Leon Baginski M D Inc

• Student in an Organized Health Care Education/Training Program in Mission Viejo, CA
• Providers in Mission Viejo, CA by specialty
• Student in an Organized Health Care Education/Training Program in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2024; 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.

Verify at the official NPI Registry.