Jimmy Seung-Sup Lee

Primary specialty

Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0808X

License

790804 Issued in CA

Practice address

1290 Tavern Rd
Mammoth Lakes, CA 93546-6601

Phone

(760) 924-1740

NPI assigned

Dec 28, 2021

Last updated

Dec 28, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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

• County of Mono

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Mammoth Lakes, CA
  • NPI 1538266911
  NPD
• Mono County Behavioral Health

  • Community/Behavioral Health Agency
  • Mammoth Lakes, CA
  • NPI 1861050643
  NPD

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

{
    "created_epoch": "1640649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640649600000",
    "number": "1689334930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100 PMB 352",
            "city": "MAMMOTH LAKES",
            "state": "CA",
            "postal_code": "93546",
            "telephone_number": "310-422-8005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1290 TAVERN RD",
            "city": "MAMMOTH LAKES",
            "state": "CA",
            "postal_code": "935466601",
            "telephone_number": "760-924-1740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "JIMMY",
        "middle_name": "SEUNG-SUP",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-12-28",
        "last_updated": "2021-12-28",
        "certification_date": "2021-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "CA",
            "license": "790804",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Collin Jeffrey Laporte, MD
• Larry M Silver MD Inc
• Patrick Lauder, M.D.
• Jenica Law, PA-C
• Michael L Lear, R.A.S.
• Jennifer Kei Kehaulani Leialoha Lane, MSTOM, HHP, L. AC.
• Han Li, LCSW
• Sara J Lokan, M.P.T.
• Kathryn Lonsdale, DPT
• Kimberly Belen Lopez

• Psychiatric/Mental Health Registered Nurse in Mammoth Lakes, CA
• Providers in Mammoth Lakes, CA by specialty
• Psychiatric/Mental Health Registered Nurse in California

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