Active NPI
Kyong-Jin Lee, MD
- Pediatric Cardiology Physician
- Palo Alto, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Cardiology Physician
- License
- C170504
- Practice address
- 725 Welch Rd
Palo Alto, CA 94304-1601 - Phone
- (650) 497-8000
- NPI assigned
- Nov 22, 2018
- 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 7
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Advanced Heart Failure and Transplant Cardiology Physician | 207RA0001X | 0101265554 | VA | |
| Adult Congenital Heart Disease Physician | 207RA0002X | 0101265554 | VA | |
| Interventional Cardiology Physician | 207RI0011X | 0101265554 | VA | |
| Pediatrics Physician | 208000000X | C170504 | CA | |
| Pediatric Adolescent Medicine Physician | 2080A0000X | 0101265554 | VA | |
| Pediatric Cardiology Physician | 2080P0202X | 0101265554 | VA | |
| Pediatric Cardiology Physician | 2080P0202X | C170504 | CA | Primary |
Addresses
Primary practice location
725 Welch Rd
Palo Alto, CA 94304-1601
Mailing address
725 Welch Rd
Palo Alto, CA 94304-1601
Phone (650) 497-8000
Other practice location 1
1250 E Marshall St
Richmond, VA 23298-5051
Phone (804) 828-2467
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: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Pediatric Medicine
- Education
- Other, 1989
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
725 Welch Rd
Palo Alto, CA 94304-1601
Phone (650) 498-7200
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C170504 | CA | MD | Pediatrics Physician |
| 0101265554 | VA | MD | Pediatric Adolescent Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Stanford Health Care | Current | Accepting new patients | |
| Stanford Health Care | Pediatrics | Current | Accepting new patients |
| Stanford Health Care | Current | Accepting new patients | |
| LPCH Medical Group Div of Lucile | Pediatrics | Current | Accepting new patients |
| Virginia Commonwealth University Health System Authority | Past | Accepting new patients | |
| Lucile Salter Packard Children'S Hospital at Stanford | Past | Accepting new patients | |
| Stanford Hospital and Clinics | Past | Accepting new patients |
Locations
7999 Gateway Blvd
Ste 200
Newark, CA 94560
Phone (510) 806-2947
725 Welch Rd
#D
Palo Alto, CA 94304
725 Welch Rd
Palo Alto, CA 94304
Phone (650) 497-8979
300 Pasteur Dr
Stanford, CA 94305
Phone (650) 498-5710
1195 W Fremont Ave
Sunnyvale, CA 94087
Phone (408) 426-5590
Organizations & group practices 7
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1542844800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1712793600000",
"number": "1417426248",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "725 WELCH RD",
"city": "PALO ALTO",
"state": "CA",
"postal_code": "943041601",
"telephone_number": "650-497-8000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "725 WELCH RD",
"city": "PALO ALTO",
"state": "CA",
"postal_code": "943041601",
"telephone_number": "650-497-8000"
}
],
"practiceLocations": [
{
"address_1": "1250 E Marshall St",
"address_purpose": "LOCATION",
"city": "Richmond",
"state": "VA",
"postal_code": "232985051",
"country_code": "US",
"telephone_number": "804-828-2467",
"fax_number": "804-828-8517",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LEE",
"first_name": "KYONG-JIN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-11-22",
"last_updated": "2024-04-11",
"certification_date": "2024-04-11",
"status": "A"
},
"taxonomies": [
{
"code": "207RA0001X",
"taxonomy_group": "",
"desc": "Internal Medicine, Advanced Heart Failure and Transplant Cardiology",
"state": "VA",
"license": "0101265554",
"primary": false
},
{
"code": "207RA0002X",
"taxonomy_group": "",
"desc": "Internal Medicine, Adult Congenital Heart Disease",
"state": "VA",
"license": "0101265554",
"primary": false
},
{
"code": "207RI0011X",
"taxonomy_group": "",
"desc": "Internal Medicine, Interventional Cardiology",
"state": "VA",
"license": "0101265554",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "C170504",
"primary": false
},
{
"code": "2080A0000X",
"taxonomy_group": "",
"desc": "Pediatrics, Adolescent Medicine",
"state": "VA",
"license": "0101265554",
"primary": false
},
{
"code": "2080P0202X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Cardiology",
"state": "VA",
"license": "0101265554",
"primary": false
},
{
"code": "2080P0202X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Cardiology",
"state": "CA",
"license": "C170504",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Palo Alto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2024; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.