Active NPI
Serena Lee
- Endodontics
- Chino, CA
National Provider Identifier
1053845180
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 104725
- Practice address
- 5562 Philadelphia St Ste 211
Chino, CA 91710-2499 - Phone
- (909) 548-0557
- NPI assigned
- Apr 14, 2017
- Last updated
- Jan 11, 2023
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 104725 | CA | Primary |
Addresses
Primary practice location
5562 Philadelphia St Ste 211
Chino, CA 91710-2499
Mailing address
601 W Woodruff Ave
Arcadia, CA 91007-8347
Other practice location 1
601 W Woodruff Ave
Arcadia, CA 91007-8347
Phone (626) 552-5006
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 104725 | CA | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1492128000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1673395200000",
"number": "1053845180",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "601 W WOODRUFF AVE",
"city": "ARCADIA",
"state": "CA",
"postal_code": "910078347"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5562 PHILADELPHIA ST STE 211",
"city": "CHINO",
"state": "CA",
"postal_code": "917102499",
"telephone_number": "909-548-0557"
}
],
"practiceLocations": [
{
"address_1": "601 W Woodruff Ave",
"address_purpose": "LOCATION",
"city": "Arcadia",
"state": "CA",
"postal_code": "910078347",
"country_code": "US",
"telephone_number": "626-552-5006",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LEE",
"first_name": "SERENA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-04-14",
"last_updated": "2023-01-11",
"certification_date": "2023-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "CA",
"license": "104725",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.