Provider Demographics
NPI:1871535971
Name:LEE, JAY (MD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3770 KEYSTONE AVE
Mailing Address - Street 2:APT. #208
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-6360
Mailing Address - Country:US
Mailing Address - Phone:323-252-7008
Mailing Address - Fax:
Practice Address - Street 1:6041 CADILLAC AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-1702
Practice Address - Country:US
Practice Address - Phone:323-857-2682
Practice Address - Fax:323-857-3915
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA83417207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A834170Medicaid
CA00A834170Medicaid
CAI29518Medicare UPIN