Active NPI
Chang Ryul Lee
- General Practice Dentistry
- Los Angeles, CA
National Provider Identifier
1225640774
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 105258
- Practice address
- 2805 S San Pedro St
Los Angeles, CA 90011-2023 - Phone
- (323) 846-8443
- NPI assigned
- Aug 17, 2020
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 105258 | CA | Primary |
Addresses
Primary practice location
2805 S San Pedro St
Los Angeles, CA 90011-2023
Mailing address
953 Elden Ave Apt 113
Los Angeles, CA 90006-5795
Phone (213) 235-7853
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)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hyung-Ju John Kim DDS Inc | Single Specialty | 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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597622400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1598400000000",
"number": "1225640774",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "953 ELDEN AVE APT 113",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900065795",
"telephone_number": "213-235-7853"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2805 S SAN PEDRO ST",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900112023",
"telephone_number": "323-846-8443"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "CHANG RYUL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-08-17",
"last_updated": "2020-08-26",
"certification_date": "2020-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "105258",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.