Active NPI
Heejoo Lee, DDS
- Periodontics
- Los Angeles, CA
National Provider Identifier
1518135656
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 36571
- Practice address
- 3460 Wilshire Blvd Ste 1007
Los Angeles, CA 90010-2232 - Phone
- (213) 365-0200
- Fax
- (213) 365-6119
- NPI assigned
- Feb 12, 2008
- 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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 36571 | CA | Primary |
Addresses
Primary practice location
3460 Wilshire Blvd Ste 1007
Los Angeles, CA 90010-2232
Mailing address
3460 Wilshire Blvd Ste 1007
Los Angeles, CA 90010-2232
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 |
|---|---|---|---|
| 36571 | CA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1202774400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1202774400000",
"number": "1518135656",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3460 WILSHIRE BLVD STE 1007",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900102232"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3460 WILSHIRE BLVD STE 1007",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900102232",
"telephone_number": "213-365-0200",
"fax_number": "213-365-6119"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "HEEJOO",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-02-12",
"last_updated": "2008-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "CA",
"license": "36571",
"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 Feb 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.