Active NPI
Bobae Lee, PA-C
- Physician Assistant
- Commerce, CA
National Provider Identifier
1417787680
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 64638
- Practice address
- 6001 E Washington Blvd
Commerce, CA 90040-2451 - Phone
- (562) 928-9600
- Fax
- (323) 477-1738
- NPI assigned
- Aug 3, 2024
- Last updated
- Oct 9, 2024
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 64638 | CA | Primary |
Addresses
Primary practice location
6001 E Washington Blvd
Commerce, CA 90040-2451
Mailing address
541 S Kroeger St
Anaheim, CA 92805-4728
Phone (970) 631-9729
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: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241029003535 | CA | Order and Referring Only - Physician Assistant | 4385177369 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 64638 | CA | MD | Physician Assistant |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Interoperability endpoints
- bobae.lee.p1@direct.fhccgla.nextgenshare.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1722643200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728432000000",
"number": "1417787680",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "541 S KROEGER ST",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "928054728",
"telephone_number": "970-631-9729"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6001 E WASHINGTON BLVD",
"city": "COMMERCE",
"state": "CA",
"postal_code": "900402451",
"telephone_number": "562-928-9600",
"fax_number": "323-477-1738"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "BOBAE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-08-03",
"last_updated": "2024-10-09",
"certification_date": "2024-10-09",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "64638",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Commerce, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.