Jaeho Joshua Lee, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA66825 Issued in CA

Practice address

133 4TH St
Gonzales, CA 93926

Phone

(831) 290-5100

Fax

(831) 290-5151

NPI assigned

Jul 1, 2024

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: gonzalesmedicalcenterinc.jaehojlee@161939.advancedmd-direct.com
• FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Gonzales Medical Center, Inc

  • Primary Care Clinic/Center
  • Gonzales, CA
  • NPI 1184176158
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1719792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777420800000",
    "number": "1013752096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2253 DAISY LN",
            "city": "LA CANADA FLINTRIDGE",
            "state": "CA",
            "postal_code": "910111412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 4TH ST",
            "city": "GONZALES",
            "state": "CA",
            "postal_code": "93926",
            "telephone_number": "831-290-5100",
            "fax_number": "831-290-5151"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "588 Longmeadow St",
            "address_purpose": "LOCATION",
            "city": "Longmeadow",
            "state": "MA",
            "postal_code": "011062292",
            "country_code": "US",
            "telephone_number": "800-782-7284",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEE",
        "first_name": "JAEHO",
        "middle_name": "JOSHUA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-07-01",
        "last_updated": "2026-04-29",
        "certification_date": "2026-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA66825",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janeth E Herrejon
• Amanda Sue Jackson, M.D.
• Holly James
• Ha Jung Kim
• Daniel Woo Kook, DDS
• Claire Michelle Lewis, PHARMD
• Daniel Gregory Luba, M.D.
• Christina Mares, MSW
• Mariposa Healing Place Corp
• Mariposa Healing Place, LLC

• All providers in Gonzales, CA
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2026; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.