Active NPI
Peter Jaikon Lee, MD, MPH
- Family Medicine Physician
- Moreno Valley, CA
National Provider Identifier
1124326574
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- A115340
- Practice address
- 26520 Cactus Ave
Moreno Valley, CA 92555-3927 - Phone
- (951) 486-4000
- NPI assigned
- Mar 9, 2011
- 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 | A115340 | CA | Primary |
Addresses
Primary practice location
26520 Cactus Ave
Moreno Valley, CA 92555-3927
Mailing address
26520 Cactus Ave
Moreno Valley, CA 92555-3927
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 |
|---|---|---|---|
| A115340 | CA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1299628800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1299628800000",
"number": "1124326574",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26520 CACTUS AVE",
"city": "MORENO VALLEY",
"state": "CA",
"postal_code": "925553927"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26520 CACTUS AVE",
"city": "MORENO VALLEY",
"state": "CA",
"postal_code": "925553927",
"telephone_number": "951-486-4000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "PETER",
"middle_name": "JAIKON",
"name_prefix": "Dr.",
"credential": "MD, MPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-03-09",
"last_updated": "2011-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "A115340",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moreno Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.