Active NPI
Ku Il Lee, D.C.
- Chiropractor
- Canyon Lake, CA
National Provider Identifier
1508193392
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(1) exclusion effective Aug 20, 2013.
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- DC27799
- Practice address
- 29806 Santa Maria Dr
Canyon Lake, CA 92587-7426 - Phone
- (951) 907-1124
- NPI assigned
- Nov 16, 2009
- 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 |
|---|---|---|---|---|
| Chiropractor | 111N00000X | DC27799 | CA | Primary |
Addresses
Primary practice location
29806 Santa Maria Dr
Canyon Lake, CA 92587-7426
Mailing address
29806 Santa Maria Dr
Canyon Lake, CA 92587-7426
Phone (951) 907-1124
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
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DC27799 | CA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1258329600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1258329600000",
"number": "1508193392",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "29806 SANTA MARIA DR",
"city": "CANYON LAKE",
"state": "CA",
"postal_code": "925877426",
"telephone_number": "951-907-1124"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "29806 SANTA MARIA DR",
"city": "CANYON LAKE",
"state": "CA",
"postal_code": "925877426",
"telephone_number": "951-907-1124"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "KU",
"middle_name": "IL",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-11-16",
"last_updated": "2009-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CA",
"license": "DC27799",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Canyon Lake, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.