Active NPI
Jong Min Lee, D.P.M
- Podiatrist
- Philadelphia, PA
National Provider Identifier
1205915444
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- SC005679
- Practice address
- 4605 Frankford Ave
Philadelphia, PA 19124-5803 - Phone
- (215) 289-7007
- Fax
- (215) 289-3400
- NPI assigned
- Nov 6, 2006
- 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 |
|---|---|---|---|---|
| Podiatrist | 213E00000X | SC005679 | PA | Primary |
Addresses
Primary practice location
4605 Frankford Ave
Philadelphia, PA 19124-5803
Mailing address
10 Liberte LN
Chesterbrook, PA 19087-5721
Phone (610) 584-4143
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10009302530001 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040414001375 | PA | Practitioner - Podiatry | 7416941075 | Practice locations: Broomall, PA; Philadelphia, PA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Charles a Friedenberg | Past | Accepting new patients | |
| Atlantic Pain and Wellness Institute PC | Past | Accepting new patients | |
| Rapha Foot and Ankle Center | Past | Accepting new patients |
Organizations & group practices 4
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.
-
- Foot & Ankle Surgery Podiatrist
- Philadelphia, PA
- NPI 1609045079
-
- Foot & Ankle Surgery Podiatrist
- Philadelphia, PA
- NPI 1629576350
-
- Pain Medicine (Anesthesiology) Physician
- Bala Cynwyd, PA
- NPI 1104852656
-
- General Practice Dentistry
- Phila, PA
- NPI 1518124023
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162771200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458604800000",
"number": "1205915444",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 LIBERTE LN",
"city": "CHESTERBROOK",
"state": "PA",
"postal_code": "190875721",
"telephone_number": "610-584-4143",
"fax_number": "610-584-4143"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4605 FRANKFORD AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191245803",
"telephone_number": "215-289-7007",
"fax_number": "215-289-3400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "JONG",
"middle_name": "MIN",
"credential": "D.P.M",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-06",
"last_updated": "2016-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "PA",
"license": "SC005679",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "10009302530001",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.