Active NPI
Olivia Seungmin Lee
- Dermatology Physician
- San Diego, CA
National Provider Identifier
1366186306
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 211074
- Practice address
- 200 W Arbor Dr
San Diego, CA 92103-9000 - Phone
- (800) 926-8273
- Fax
- (888) 539-8781
- NPI assigned
- Apr 26, 2022
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Dermatology Physician | 207N00000X | 211074 | CA | Primary |
Addresses
Primary practice location
200 W Arbor Dr
San Diego, CA 92103-9000
Mailing address
File 57326
Los Angeles, CA 90074-7326
Phone (800) 926-8273
Other practice location 1
1500 E Medical Center Dr
Ann Arbor, MI 48109-5000
Phone (734) 936-4054
Other practice location 2
8899 University Center Ln
San Diego, CA 92122-1013
Phone (800) 926-8273
Medicare participation
Medicare enrollment files- 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: Yes
- Hospice: Yes
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1650931200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1786924800000",
"number": "1366186306",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "FILE 57326",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900747326",
"telephone_number": "800-926-8273"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 W ARBOR DR",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921039000",
"telephone_number": "800-926-8273",
"fax_number": "888-539-8781"
}
],
"practiceLocations": [
{
"address_1": "1500 E Medical Center Dr",
"address_purpose": "LOCATION",
"city": "Ann Arbor",
"state": "MI",
"postal_code": "481095000",
"country_code": "US",
"telephone_number": "734-936-4054",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "8899 University Center Ln",
"address_purpose": "LOCATION",
"city": "San Diego",
"state": "CA",
"postal_code": "921221013",
"country_code": "US",
"telephone_number": "800-926-8273",
"fax_number": "888-539-8781",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LEE",
"first_name": "OLIVIA",
"middle_name": "SEUNGMIN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-04-26",
"last_updated": "2026-08-17",
"certification_date": "2026-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "CA",
"license": "211074",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2026; 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.