Individual provider Active NPI

Alice Lee, DO

  • Student in an Organized Health Care Education/Training Program
  • Loma Linda, CA
National Provider Identifier
1609571785
Registry record updated Jun 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
11234 Anderson Street
Gme Office Westerly Suite C
Loma Linda, CA 92354
Phone
(909) 558-6688
NPI assigned
Mar 30, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 22, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 25MB13129100 NJ
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

11234 Anderson Street
Gme Office Westerly Suite C
Loma Linda, CA 92354

Mailing address

308 Willow Ave
Hoboken, NJ 07030-3808
Phone (201) 418-3127

Other practice location 1

308 Willow Ave
Hoboken, NJ 07030-3808
Phone (201) 418-3127

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
Credentials
Doctor of Osteopathy

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1680134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782086400000",
    "number": "1609571785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 WILLOW AVE",
            "city": "HOBOKEN",
            "state": "NJ",
            "postal_code": "070303808",
            "telephone_number": "201-418-3127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11234 ANDERSON STREET",
            "address_2": "GME OFFICE WESTERLY SUITE C",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "92354",
            "telephone_number": "909-558-6688"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "308 Willow Ave",
            "address_purpose": "LOCATION",
            "city": "Hoboken",
            "state": "NJ",
            "postal_code": "070303808",
            "country_code": "US",
            "telephone_number": "201-418-3127",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEE",
        "first_name": "ALICE",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-03-30",
        "last_updated": "2026-06-22",
        "certification_date": "2026-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MB13129100",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Loma Linda, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.