Kwang Yeon Carol Lee

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

95015771 Issued in CA

Practice address

101 The City Dr S
Orange, CA 92868-3298

Phone

(714) 880-7812

NPI assigned

Oct 27, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: carol.lee.1@5054.direct.athenahealth.com

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.

• Kaushal R Tamboli MD Inc

  • Cardiovascular Disease Physician
  • Downey, CA
  • NPI 1881756492
  Medicare reassignment NPD
• Regents of the University of

  • Anesthesiology Physician
  • Orange, CA
  • NPI 1487602546
  Medicare reassignment NPD

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

{
    "created_epoch": "1603756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603756800000",
    "number": "1164022448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2119 WINTERWOOD DR",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928331251",
            "telephone_number": "310-694-4318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 THE CITY DR S",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683298",
            "telephone_number": "714-880-7812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "KWANG YEON CAROL",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-27",
        "last_updated": "2020-10-27",
        "certification_date": "2020-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "CA",
            "license": "95015771",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jung Won Lee, OTR/L
• Justin Scott Lee, M.D.
• Kaitlyn Lee
• Kathleen Yulim Lee
• Kiana Lee
• Mackenzie Chunting Lee
• Mark Y Lee, MD
• Mi Sun Lee, OTR/L
• Miranda Boey Lee
• Myeongcheol Lee, LAC

• Acute Care Nurse Practitioner in Orange, CA
• Providers in Orange, CA by specialty
• Acute Care Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2020; 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.