NPIMap

Individual provider Active NPI

Sun Ik Lee, MD

  • Neurological Surgery Physician
  • Modesto, CA
National Provider Identifier
1376804757
Registry record updated Nov 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
A140655 Issued in CA
Practice address
4016 Dale Rd
Modesto, CA 95356-9268
Phone
(209) 571-0288
Fax
(209) 571-0327
NPI assigned
Jun 1, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 8, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X MD. 203337 LA
Neurological Surgery Physician 207T00000X A140655 CA Primary
Neurological Surgery Physician 207T00000X 27123 NE

Addresses

Primary practice location

4016 Dale Rd
Modesto, CA 95356-9268

Mailing address

PO Box 36833
Belfast, ME 04915-1210
Phone (209) 571-0288

Other identifiers 1

IdentifierTypeStateIssuer
1437184652MedicaidNE

Other names 1

  • Sun Ik Lee Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160922001992 CA Practitioner - Orthopedic Surgery 2062654346 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Loma Linda University School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4016 Dale Rd
Modesto, CA 95356-9268
Phone (209) 571-0288

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion55
Laminectomy or laminotomy (partial removal of spine bones)20

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A140655CAMDNeurological Surgery Physician
27123NEMDNeurological Surgery Physician
MD. 203337LAMDGeneral Acute Care Hospital

Practice roles

OrganizationSpecialtyStatusNew patients
University of California San Francisco Current Accepting new patients
Sun Ik Lee MD Inc a Professional Medical Corporation Neurological Surgery CurrentSince Aug 1, 2023 Accepting new patients
University of California San Francisco CurrentSince Aug 25, 2016 Accepting new patients
University of California San Francisco CurrentSince Aug 25, 2016 Accepting new patients
UCSF Medical Group Business Services CurrentSince Aug 25, 2016 Accepting new patients
UCSF Medical Group Business Services Neurological Surgery CurrentSince Aug 25, 2016 Accepting new patients

Locations

4016 Dale Rd
Modesto, CA 95356
Phone (209) 571-0288

1411 E 31st St
#22134
Oakland, CA 94602
Phone (510) 437-4401

1411 E 31st St
Oakland, CA 94602
Phone (510) 437-4323

2330 Post St
San Francisco, CA 94115
Phone (415) 502-4444

400 Parnassus Ave
San Francisco, CA 94143
Phone (415) 353-2000

3333 California St
#S110
San Francisco, CA 94118
Phone (415) 514-2664

400 Parnassus Ave
#300
San Francisco, CA 94143
Phone (415) 476-2163

400 Parnassus Ave
#A632
San Francisco, CA 94143
Phone (415) 473-1000

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: sun.ik.lee.1@16567.direct.athenahealth.com

Organizations & group practices 6

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.

Hospital & facility affiliations 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1338508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699401600000",
    "number": "1376804757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 36833",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049151210",
            "telephone_number": "209-571-0288",
            "fax_number": "209-571-0327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4016 DALE RD",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953569268",
            "telephone_number": "209-571-0288",
            "fax_number": "209-571-0327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "SUN IK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-06-01",
        "last_updated": "2023-11-08",
        "certification_date": "2023-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "LA",
            "license": "MD. 203337",
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "CA",
            "license": "A140655",
            "primary": true
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "NE",
            "license": "27123",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1437184652",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUN IK",
            "last_name": "LEE",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Modesto, CA

Sources for this page

Verify at the official NPI Registry.