Active NPI
Jin Ho Lee, D.M.D
- General Practice Dentistry
- Los Angeles, CA
National Provider Identifier
1366618811
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 50774
- Practice address
- 3224 W Olympic Blvd
#201
Los Angeles, CA 90006-2317 - Phone
- (323) 737-1001
- NPI assigned
- May 5, 2008
- 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 | 50774 | CA | Primary |
Addresses
Primary practice location
3224 W Olympic Blvd
#201
Los Angeles, CA 90006-2317
Mailing address
3224 W Olympic Blvd
#201
Los Angeles, CA 90006-2317
Phone (323) 737-1001
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200430002522 | CA | Practitioner - Dentist | 4981034345 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50774 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1209945600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209945600000",
"number": "1366618811",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3224 W OLYMPIC BLVD",
"address_2": "#201",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900062317",
"telephone_number": "323-737-1001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3224 W OLYMPIC BLVD",
"address_2": "#201",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900062317",
"telephone_number": "323-737-1001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "JIN",
"middle_name": "HO",
"name_prefix": "Dr.",
"credential": "D.M.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-05-05",
"last_updated": "2008-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "50774",
"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 May 5, 2008; 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.