Active NPI
Phominik T Lee
- Non-emergency Medical Transport (VAN)
- Sacramento, CA
National Provider Identifier
1609043652
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Non-emergency Medical Transport (VAN)
- Practice address
- 8670 Kelwood Way
Same
Sacramento, CA 95828-3858 - Phone
- (916) 230-8494
- NPI assigned
- May 9, 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | CA | ||
| Non-emergency Medical Transport (VAN) | 343900000X | CA | Primary | |
| Private Vehicle | 347C00000X | CA |
Addresses
Primary practice location
8670 Kelwood Way
Same
Sacramento, CA 95828-3858
Mailing address
8670 Kelwood Way
Same
Sacramento, CA 95828-3858
Phone (916) 230-8494
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 99 | Medicaid | CA |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210291200000",
"number": "1609043652",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8670 KELWOOD WAY",
"address_2": "SAME",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958283858",
"telephone_number": "916-230-8494"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8670 KELWOOD WAY",
"address_2": "SAME",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958283858",
"telephone_number": "916-230-8494"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "PHOMINIK",
"middle_name": "T",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-05-09",
"last_updated": "2008-05-09",
"status": "A"
},
"taxonomies": [
{
"code": "172A00000X",
"taxonomy_group": "",
"desc": "Driver",
"state": "CA",
"license": null,
"primary": false
},
{
"code": "343900000X",
"taxonomy_group": "",
"desc": "Non-emergency Medical Transport (VAN)",
"state": "CA",
"license": null,
"primary": true
},
{
"code": "347C00000X",
"taxonomy_group": "",
"desc": "Private Vehicle",
"state": "CA",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "99",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 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.