Soonki Lee, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

62164 Issued in CA

Practice address

3030 W Olympic Blvd Ste 216
Los Angeles, CA 90006-6507

Phone

(213) 384-1036

NPI assigned

Aug 9, 2012

Last updated

Feb 5, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jun 23, 2025 through Jun 23, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• S.K.Lee, DDS, PC.

  • Dental Clinic/Center
  • Diamond Bar, CA
  • NPI 1902408305
  NPD (past) Authorized official
• Soonki Lee DDS PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Los Angeles, CA
  • NPI 1033618681
  Authorized official Same address or phone

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

{
    "created_epoch": "1344470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1517788800000",
    "number": "1255688214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3030 W OLYMPIC BLVD STE 216",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900066507",
            "telephone_number": "213-384-1036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3030 W OLYMPIC BLVD STE 216",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900066507",
            "telephone_number": "213-384-1036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "SOONKI",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-08-09",
        "last_updated": "2018-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "62164",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Soo Jin Lee, CM-II
• Soo Rok Lee
• Soo-Min S Lee, NP
• Sooin Lee, NP
• Soonja C Lee, PSYCHOLOGIST
• Sophia Jin Lee, D.D.S.
• Sophie Minnie Lee
• Stella Jieun Lee, M.D.
• Stella Seunghee Lee
• Stephanie Lee, CCC-SLP

• General Practice Dentistry in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2018; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.