NPIMap

Individual provider Active NPI

Jason S Lee, DDS

  • General Practice Dentistry
  • Upland, CA
National Provider Identifier
1528112257
Registry record updated Dec 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
47386 Issued in CA
Practice address
1183 E Foothill Blvd
Unit 240
Upland, CA 91786-4049
Phone
(909) 981-6882
Fax
(909) 981-0276
NPI assigned
Jan 22, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2008

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 47386 CA Primary

Addresses

Primary practice location

1183 E Foothill Blvd
Unit 240
Upland, CA 91786-4049

Mailing address

1183 E Foothill Blvd
Unit 240
Upland, CA 91786-4049
Phone (909) 981-6882

Other identifiers 1

IdentifierTypeStateIssuer
D47386MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
47386CAMDPharmacist

NPI Registry JSON

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1230422400000",
    "number": "1528112257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1183 E FOOTHILL BLVD",
            "address_2": "UNIT 240",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864049",
            "telephone_number": "909-981-6882",
            "fax_number": "909-981-0276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1183 E FOOTHILL BLVD",
            "address_2": "UNIT 240",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864049",
            "telephone_number": "909-981-6882",
            "fax_number": "909-981-0276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "JASON",
        "middle_name": "S",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-22",
        "last_updated": "2008-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "47386",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D47386",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Upland, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2008; 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.