NPIMap

Individual provider Active NPI

Nicole Nakyung Lee, MD

  • Diagnostic Radiology Physician
  • San Mateo, CA
National Provider Identifier
1669615183
Registry record updated Mar 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
C160807 Issued in CA
Practice address
100 S San Mateo Dr
San Mateo, CA 94401-3805
Phone
(650) 696-4140
Fax
(650) 696-4637
NPI assigned
Apr 14, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X C160807 CA Primary

Addresses

Primary practice location

100 S San Mateo Dr
San Mateo, CA 94401-3805

Mailing address

PO Box 6102
Novato, CA 94948-6102
Phone (415) 884-9125

Other practice location 1

222 W 39th Ave
San Mateo, CA 94403-4364
Phone (650) 573-2681

Other practice location 2

1501 Trousdale Dr
Burlingame, CA 94010-4506
Phone (650) 696-5509

Other identifiers 3

IdentifierTypeStateIssuer
1021958MedicaidVT
3077513MedicaidNH
100170487MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201029000678 CA Practitioner - Diagnostic Radiology 4284896283 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Oregon Health Sciences University School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sutter Bay Medical FoundationGroup PAC ID 4284538778, 3,783 clinicians
California Advanced Imaging Medical Associates IncGroup PAC ID 0244144228, 85 clinicians
County of San MateoGroup PAC ID 9032023171, shared by 15 NPIs, 316 clinicians
Sutter Valley Medical FoundationGroup PAC ID 9830094515, 2,473 clinicians

Practice addresses (Care Compare)

123 S San Mateo Dr
San Mateo, CA 94401-3804
Phone (650) 343-4200

1501 Trousdale Dr
Burlingame, CA 94010-4506
Phone (650) 696-5515

222 W 39TH Ave
San Mateo, CA 94403-4364
Phone (650) 573-2222

2505 W Hammer LN
Stockton, CA 95209-2839
Phone (209) 957-7050

2545 W Hammer LN
Stockton, CA 95209-2839
Phone (209) 957-7050

600 Coffee Rd
Modesto, CA 95355-4201
Phone (209) 524-1211

795 El Camino Real
Palo Alto, CA 94301-2302
Phone (415) 600-1020

815 Court St
Jackson, CA 95642-2154

901 Campus Dr
Daly City, CA 94015-4900
Phone (650) 652-8500

Hospital & facility affiliations

  • Peninsula Medical Center Hospital, Burlingame, CA, CCN 050007
  • San Mateo Medical Center Hospital, San Mateo, CA, CCN 050113
  • Sutter Lakeside Hospital Hospital, Lakeport, CA, CCN 051329
  • Stanford Health Care Hospital, Stanford, CA, CCN 050441
  • UCSF Medical Center Hospital, San Francisco, CA, CCN 050454

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
C160807CAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter Bay Medical Foundation CurrentSince Dec 2, 2024 Accepting new patients
Sutter Valley Medical Foundation Diagnostic Radiology Current Accepting new patients
Sutter Valley Medical Foundation CurrentSince Nov 1, 2025 Accepting new patients
Sutter Bay Medical Foundation CurrentSince Dec 2, 2024 Accepting new patients
County of San Mateo CurrentSince Jan 23, 2025 Accepting new patients
Permanente Medical Group Inc Diagnostic Radiology CurrentSince Jul 29, 2020 Accepting new patients
Permanente Medical Group, Inc CurrentSince Jul 29, 2020 Accepting new patients
County of San Mateo CurrentSince Jan 23, 2025 Accepting new patients
Sutter Valley Medical Foundation CurrentSince Nov 1, 2025 Accepting new patients
County of San Mateo CurrentSince Jan 23, 2025 Accepting new patients
Permanente Medical Group Inc Diagnostic Radiology Current Accepting new patients
California Advanced Imaging Medical Associates Inc Diagnostic Radiology CurrentSince Nov 15, 2024 Accepting new patients

Locations (25 of 42)

18400 US Highway 18
Apple Valley, CA 92307
Phone (760) 810-7590

750 Auburn Ravine Rd
Auburn, CA 95603
Phone (530) 823-6131

350 John Muir Pkwy
Ste 160
Brentwood, CA 94513
Phone (925) 204-1920

1501 Trousdale Dr
Burlingame, CA 94010
Phone (650) 696-3520

1950 University Ave
Ste 160
East Palo Alto, CA 94303
Phone (650) 317-8100

2720 Low Ct
Fairfield, CA 94534
Phone (707) 428-2731

3200 Kearney St
Fremont, CA 94538
Phone (510) 498-2800

4753 W Shaw Ave
Ste 101
Fresno, CA 93722
Phone (559) 277-8738

1189 E Herndon Ave
Ste 103
Fresno, CA 93720
Phone (559) 450-7777

1260 S Eliseo Dr
Ste 101
Greenbrae, CA 94904
Phone (415) 461-9033

900 N Douty St
Hanford, CA 93230
Phone (559) 587-9014

815 Court St
Ste 7
Jackson, CA 95642
Phone (209) 257-5900

370 Distel Cir
Los Altos, CA 94022
Phone (650) 254-5200

600 Coffee Rd
Modesto, CA 95355
Phone (209) 550-4755

101 Rowland Way
Ste 220
Novato, CA 94945
Phone (415) 878-7200

795 El Camino Real
Palo Alto, CA 94301
Phone (650) 324-1832

101 Monroe St
Petaluma, CA 94954
Phone (707) 763-4109

1555 East St
Ste 200
Redding, CA 96001
Phone (530) 229-0911

1150 Veterans Blvd
Redwood City, CA 94063
Phone (650) 299-2015

901 Nevin Ave
Richmond, CA 94801
Phone (510) 307-1500

930 W Main St
Ripon, CA 95366
Phone (209) 599-4221

151 N Sunrise Ave
Ste 1205
Roseville, CA 95661
Phone (916) 789-1505

2800 L St
Ste 500
Sacramento, CA 95816
Phone (916) 454-6850

501 J St
Sacramento, CA 95814
Phone (916) 497-3000

3838 California St
Rm 410
San Francisco, CA 94118
Phone (415) 751-1847

Interoperability endpoints

  • Direct secure messaging: nlee714089@hisp.ehr.sutterhealth.org

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 19

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1239667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743120000000",
    "number": "1669615183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6102",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949486102",
            "telephone_number": "415-884-9125",
            "fax_number": "415-883-0877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 S SAN MATEO DR",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944013805",
            "telephone_number": "650-696-4140",
            "fax_number": "650-696-4637"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "222 W 39th Ave",
            "address_purpose": "LOCATION",
            "city": "San Mateo",
            "state": "CA",
            "postal_code": "944034364",
            "country_code": "US",
            "telephone_number": "650-573-2681",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1501 Trousdale Dr",
            "address_purpose": "LOCATION",
            "city": "Burlingame",
            "state": "CA",
            "postal_code": "940104506",
            "country_code": "US",
            "telephone_number": "650-696-5509",
            "fax_number": "650-696-5995",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEE",
        "first_name": "NICOLE",
        "middle_name": "NAKYUNG",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-14",
        "last_updated": "2025-03-28",
        "certification_date": "2025-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "C160807",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1021958",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3077513",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100170487",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Mateo, CA

Sources for this page

Verify at the official NPI Registry.