Active NPI
John Lee, D.D.S
- General Practice Dentistry
- Livermore, CA
National Provider Identifier
1609900786
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 34634
- Practice address
- 60 Fenton St
Su. 3
Livermore, CA 94550-4148 - Phone
- (925) 449-1232
- Fax
- (925) 449-3936
- NPI assigned
- Mar 14, 2007
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 34634 | CA | Primary |
Addresses
Primary practice location
60 Fenton St
Su. 3
Livermore, CA 94550-4148
Mailing address
60 Fenton St
Su. 3
Livermore, CA 94550-4148
Phone (925) 449-1232
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: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150521001998 | CA | Order and Referring Only - Dentist | 5092035683 |
Care Compare profile
Medicare Care Compare- Specialty
- Dentist
- Education
- Emory University School of Medicine, 1986
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
2276 E Riverside Dr
St George, UT 84790-2636
5217 S State St
Suite 201
Murray, UT 84107-4812
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173830400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1609900786",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "60 FENTON ST",
"address_2": "SU. 3",
"city": "LIVERMORE",
"state": "CA",
"postal_code": "945504148",
"telephone_number": "925-449-1232",
"fax_number": "925-449-3936"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "60 FENTON ST",
"address_2": "SU. 3",
"city": "LIVERMORE",
"state": "CA",
"postal_code": "945504148",
"telephone_number": "925-449-1232",
"fax_number": "925-449-3936"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "JOHN",
"name_prefix": "Dr.",
"credential": "D.D.S",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "34634",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Livermore, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.