Individual
JASON LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
714 TIVERTON AVE, LOS ANGELES, CA 90095-8361
(310) 825-0834
Mailing address
622 W 168TH ST, NEW YORK, NY 10032-3720
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
111720
CA
Other
Enumeration date
03/20/2023
Last updated
06/20/2025
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