Active NPI
Eliza Lee, DDS
- Dentist
- Rowland Heights, CA
National Provider Identifier
1184151045
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 104496
- Practice address
- 1746 Nogales St
Rowland Heights, CA 91748 - Phone
- (626) 913-6650
- NPI assigned
- May 22, 2017
- Last updated
- Dec 4, 2019
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 104496 | CA | Primary |
Addresses
Primary practice location
1746 Nogales St
Rowland Heights, CA 91748
Mailing address
1616 Range CT
Diamond Bar, CA 91765-4318
Phone (415) 637-8341
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: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210813001829 | CA | Order and Referring Only - Dentist | 6709280639 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 104496 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Debra & Robin Im DDS, Inc. | Dentist | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Dentist
- Rowland Heights, CA
- NPI 1013860659
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1495411200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1575417600000",
"number": "1184151045",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1616 RANGE CT",
"city": "DIAMOND BAR",
"state": "CA",
"postal_code": "917654318",
"telephone_number": "415-637-8341"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1746 NOGALES ST",
"city": "ROWLAND HEIGHTS",
"state": "CA",
"postal_code": "91748",
"telephone_number": "626-913-6650"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "ELIZA",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-05-22",
"last_updated": "2019-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "104496",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rowland Heights, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2019; 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.