Active NPI
Jason Lee
- Oral and Maxillofacial Surgery (Dentist)
- Los Angeles, CA
National Provider Identifier
1790487403
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)
- License
- 111720
- Practice address
- 714 Tiverton Ave
Los Angeles, CA 90095-8361 - Phone
- (310) 825-0834
- NPI assigned
- Mar 20, 2023
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 111720 | CA | Primary |
Addresses
Primary practice location
714 Tiverton Ave
Los Angeles, CA 90095-8361
Mailing address
622 W 168TH St
New York, NY 10032-3720
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 111720 | CA | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1679270400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1750377600000",
"number": "1790487403",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "622 W 168TH ST",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100323720"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "714 TIVERTON AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900958361",
"telephone_number": "310-825-0834"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "JASON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-03-20",
"last_updated": "2025-06-20",
"certification_date": "2025-06-20",
"status": "A"
},
"taxonomies": [
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "CA",
"license": "111720",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.