Provider Demographics
NPI:1720007420
Name:LEE, JAI H (MD)
Entity Type:Individual
Prefix:DR
First Name:JAI
Middle Name:H
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1035 S VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2710
Mailing Address - Country:US
Mailing Address - Phone:213-387-0102
Mailing Address - Fax:213-738-8764
Practice Address - Street 1:1225 E LATHAM AVE
Practice Address - Street 2:STE A
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4423
Practice Address - Country:US
Practice Address - Phone:951-652-8700
Practice Address - Fax:951-766-9944
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38492207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA38492OtherCA LICENSE
CAA38492Medicare ID - Type Unspecified
CAA38492OtherCA LICENSE