Individual provider Active NPI

Hee Tae Lee

  • Psychiatric/Mental Health Nurse Practitioner
  • Los Angeles, CA
National Provider Identifier
1174415749
Registry record updated Dec 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
95037221 Issued in CA
Practice address
3030 W Olympic Blvd Ste 217
Los Angeles, CA 90006-6507
Phone
(213) 703-5526
NPI assigned
Jul 17, 2025
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 1, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 95037221 CA Primary
Registered Nurse 163W00000X 95231436 CA

Addresses

Primary practice location

3030 W Olympic Blvd Ste 217
Los Angeles, CA 90006-6507

Mailing address

2466 Montrose Ave Apt 2
Montrose, CA 91020-1476
Phone (213) 703-5526

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20260409003258 CA Practitioner - Nurse Practitioner 6002381779 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

2466 Montrose Ave
Apt 2
Montrose, CA 91020-1476

2466 Montrose Ave Apt
Suite 2
Montrose, CA 91020-1476

3030 W Olympic Blvd
Suite 217
Los Angeles, CA 90006-6507

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
95231436CAMDRegistered Nurse

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1752710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764547200000",
    "number": "1174415749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2466 MONTROSE AVE APT 2",
            "city": "MONTROSE",
            "state": "CA",
            "postal_code": "910201476",
            "telephone_number": "213-703-5526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3030 W OLYMPIC BLVD STE 217",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900066507",
            "telephone_number": "213-703-5526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "HEE TAE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-07-17",
        "last_updated": "2025-12-01",
        "certification_date": "2025-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95037221",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95231436",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.