Active NPI
Jeffrey Lum
- Physical Therapist
- San Pedro, CA
National Provider Identifier
1376136366
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 299662
- Practice address
- 1360 W 6TH St Ste 210
San Pedro, CA 90732-3590 - Phone
- (310) 548-3130
- NPI assigned
- Feb 19, 2021
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 299662 | CA | Primary |
Addresses
Primary practice location
1360 W 6TH St Ste 210
San Pedro, CA 90732-3590
Mailing address
921 S Amherst Cir
Anaheim, CA 92807-5001
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 299662 | CA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Praxis Physical Therapy, Inc. | Multi-Specialty | Current | Accepting new patients |
Locations
1360 W 6th St
Ste 210
San Pedro, CA 90732
Phone (310) 548-3130
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": "1613692800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613692800000",
"number": "1376136366",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "921 S AMHERST CIR",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "928075001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1360 W 6TH ST STE 210",
"city": "SAN PEDRO",
"state": "CA",
"postal_code": "907323590",
"telephone_number": "310-548-3130"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUM",
"first_name": "JEFFREY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-02-19",
"last_updated": "2021-02-19",
"certification_date": "2021-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physical Therapist",
"state": "CA",
"license": "299662",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Pedro, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.