Active NPI
Jong D Lee, M.D.
- Family Medicine Physician
- Garden Grove, CA
National Provider Identifier
1023259819
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- C39144
- Practice address
- 9828 Garden Grove Blvd Ste 201
Garden Grove, CA 92844-1659 - Phone
- (714) 530-9633
- Fax
- (714) 530-4410
- NPI assigned
- Mar 9, 2009
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | C39144 | CA | Primary |
Addresses
Primary practice location
9828 Garden Grove Blvd Ste 201
Garden Grove, CA 92844-1659
Mailing address
9828 Garden Grove Blvd Ste 201
Garden Grove, CA 92844-1659
Phone (714) 530-9633
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C39144 | Other | CA | STATE LICENSE |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C39144 | CA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1236556800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1236556800000",
"number": "1023259819",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9828 GARDEN GROVE BLVD STE 201",
"city": "GARDEN GROVE",
"state": "CA",
"postal_code": "928441659",
"telephone_number": "714-530-9633",
"fax_number": "714-530-4410"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9828 GARDEN GROVE BLVD STE 201",
"city": "GARDEN GROVE",
"state": "CA",
"postal_code": "928441659",
"telephone_number": "714-530-9633",
"fax_number": "714-530-4410"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "JONG",
"middle_name": "D",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-03-09",
"last_updated": "2009-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "C39144",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "C39144",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Garden Grove, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.