Jae Yong Lee, PT, DPT, CSCS, TSACF

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT300566 Issued in CA

Practice address

11301 Wilshire Blvd
Los Angeles, CA 90073-1003

Phone

(310) 478-3711

NPI assigned

Oct 28, 2021

Last updated

Oct 28, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1635379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635379200000",
    "number": "1639833312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "524 HUGHES ST",
            "city": "NORTHVALE",
            "state": "NJ",
            "postal_code": "076471019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11301 WILSHIRE BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900731003",
            "telephone_number": "310-478-3711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "JAE YONG",
        "name_prefix": "Dr.",
        "credential": "PT, DPT, CSCS, TSACF",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-10-28",
        "last_updated": "2021-10-28",
        "certification_date": "2021-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT300566",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "JaeYong.Lee@va.gov",
            "affiliation": "Y",
            "affiliationName": "Dep. veterans Affairs",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1660 south columbian way",
            "address_2": "puget sound health care system",
            "city": "Seattle",
            "state": "WA",
            "country_code": "US",
            "postal_code": "981081597",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jae H. Lee, M.D.
• Jae Ho Lee
• Jae W Lee, M.D.
• Jae Woo Lee, MD
• Jae Yong Lee, D.D.S.
• Jaehee Lee, FNP-BC
• Jaejoon Lee
• Jaiho Lee
• James Lee
• James Lee

• Physical Therapist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2021; 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.