Individual provider Active NPI

Eric Gim Lee, DC, NP

  • Family Nurse Practitioner
  • Westchester, CA
National Provider Identifier
1245337872
Registry record updated Jul 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
NP95020519 Issued in CA
Practice address
6506 Arizona Ave
Westchester, CA 90045-1330
Phone
(424) 339-7577
NPI assigned
Sep 17, 2006
Last updated
Jul 21, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95020519 CA
Family Nurse Practitioner 363LF0000X NP95020519 CA Primary
Chiropractor 111N00000X DC25160 CA

Addresses

Primary practice location

6506 Arizona Ave
Westchester, CA 90045-1330

Mailing address

1150 W Capitol Dr Unit 38
San Pedro, CA 90732-2269
Phone (310) 325-7246

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20031222000445 CA Practitioner - Chiropractic 3779481262 Reassigns benefits to 1 organization
I20220914001014 CA Practitioner - Nurse Practitioner 3779481262 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern California Neuro Medical Services IncGroup PAC ID 9638567753, 6 clinicians

Practice addresses (Care Compare)

4560 Admiralty Way
Marina del Rey, CA 90292-5448
Phone (310) 306-8876

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
25160CAMDClinical Psychologist
DC25160CAMDChiropractor
95020519CAMDFamily Nurse Practitioner
NP95020519CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Neuro Medical Services Inc CurrentSince Aug 10, 2022 Accepting new patients
Avalon Wellness Center Chiropractor Past Accepting new patients

Locations

4560 Admiralty Way
Ste 352
Marina del Rey, CA 90292
Phone (310) 306-8876

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1158451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721520000000",
    "number": "1245337872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 W CAPITOL DR UNIT 38",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907322269",
            "telephone_number": "310-325-7246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6506 ARIZONA AVE",
            "city": "WESTCHESTER",
            "state": "CA",
            "postal_code": "900451330",
            "telephone_number": "424-339-7577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "ERIC",
        "middle_name": "GIM",
        "credential": "DC, NP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-17",
        "last_updated": "2024-07-21",
        "certification_date": "2024-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95020519",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "NP95020519",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "DC25160",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Westchester, CA

Sources for this page

Verify at the official NPI Registry.