Active NPI
Collin Kyongmin Lee
- Dentist
- Los Angeles, CA
National Provider Identifier
1427604776
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 104271
- Practice address
- 1000 E Washington Blvd Ste 112
Los Angeles, CA 90021-3070 - Phone
- (213) 973-5180
- NPI assigned
- Aug 13, 2019
- Last updated
- Aug 13, 2019
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 104271 | CA | Primary |
Addresses
Primary practice location
1000 E Washington Blvd Ste 112
Los Angeles, CA 90021-3070
Mailing address
1717 Solejar Dr
La Habra Heights, CA 90631-8686
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 104271 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1565654400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1565654400000",
"number": "1427604776",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1717 SOLEJAR DR",
"city": "LA HABRA HEIGHTS",
"state": "CA",
"postal_code": "906318686"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 E WASHINGTON BLVD STE 112",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900213070",
"telephone_number": "213-973-5180"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "COLLIN",
"middle_name": "KYONGMIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-08-13",
"last_updated": "2019-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "104271",
"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 Aug 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.