Individual provider Active NPI

Keith J Lee, MD

  • Internal Medicine Physician
  • Irvine, CA
National Provider Identifier
1699766188
Registry record updated Oct 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
G52059 Issued in CA
Practice address
4050 Barranca Pkwy
Suite 200
Irvine, CA 92604-7706
Phone
(949) 551-1090
Fax
(949) 262-5500
NPI assigned
Nov 2, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X G52059 CA Primary

Addresses

Primary practice location

4050 Barranca Pkwy
Suite 200
Irvine, CA 92604-7706

Mailing address

17360 Brookhurst St
Attn: MCMF Credentialing Dept.
Fountain Valley, CA 92708-3720

Other identifiers 1

IdentifierTypeStateIssuer
00G520590MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100315000374 CA Practitioner - Internal Medicine 1153456231 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Southern California Keck School of Medicine, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Memorialcare Medical FoundationGroup PAC ID 8729277314, 555 clinicians

Practice addresses (Care Compare)

100 S Anaheim Blvd
Suite 101
Anaheim, CA 92805-3848
Phone (714) 826-1200

11420 Warner Ave
Fountain Valley, CA 92708-2529
Phone (714) 549-1300

1212 W 17TH St
Santa Ana, CA 92706-3418
Phone (714) 954-0432

14150 Culver Dr
Suite 100
Irvine, CA 92604-0322
Phone (949) 552-4584

18102 Culver Dr
Irvine, CA 92612-2730
Phone (657) 241-8220

18111 Brookhurst St
Suite 6100
Fountain Valley, CA 92708-6728
Phone (714) 378-7330

23512 Madero
Mission Viejo, CA 92691-2743
Phone (949) 583-1600

24268 El Toro Rd
Laguna Woods, CA 92637-3435
Phone (657) 241-8455

29472 Avenida de Las Bandera
Rancho Santa Margarita, CA 92688-2651
Phone (949) 459-9968

30492 Gateway PL
Suite 110
Rancho Mission Viejo, CA 92694-1862
Phone (657) 241-8435

3828 Schaufele Ave
Long Beach, CA 90808-1793

4050 Barranca Pkwy
Suite 200
Irvine, CA 92604-1723
Phone (949) 551-1090

4950 Barranca Pkwy
Suite 104
Irvine, CA 92604-8644
Phone (949) 857-1248

722 Baker St
Costa Mesa, CA 92626-4320
Phone (714) 557-6300

9122 Adams Ave
Huntington Beach, CA 92646-3405
Phone (714) 378-0900

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G52059CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Memorialcare Medical Foundation Internal Medicine CurrentSince Feb 1, 2011 Accepting new patients
Children's Hospital of Orange County Past Accepting new patients
Bristol Park Medical Group, Inc Internal Medicine Past Accepting new patients
Long Beach Memorial Medical Past Accepting new patients
Long Beach Memorial Medical Past Accepting new patients
Mission Hospital Regional Medical Center Past Accepting new patients
Children's Hospital at Mission Past Accepting new patients
Saddleback Memorial Medical Center Past Accepting new patients
Orange Coast Memorial Medical Center Past Accepting new patients

Locations

722 Baker St
Costa Mesa, CA 92626
Phone (714) 557-6300

11420 Warner Ave
Fountain Vly, CA 92708
Phone (714) 549-1300

17360 Brookhurst St
Fountain Vly, CA 92708
Phone (657) 241-3592

250 E Yale Loop
Ste 200
Irvine, CA 92604
Phone (844) 315-2229

4050 Barranca Pkwy
Ste 200
Irvine, CA 92604
Phone (949) 551-1090

2742 Dow Ave
Tustin, CA 92780
Phone (714) 665-1600

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: klee76538@direct.memorialcare.org

Organizations & group practices 9

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 2

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

NPI Registry JSON

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444694400000",
    "number": "1699766188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17360 BROOKHURST ST",
            "address_2": "ATTN: MCMF CREDENTIALING DEPT.",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927083720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4050 BARRANCA PKWY",
            "address_2": "SUITE 200",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926047706",
            "telephone_number": "949-551-1090",
            "fax_number": "949-262-5500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "KEITH",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-02",
        "last_updated": "2015-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G52059",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G520590",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Irvine, CA

Sources for this page

Verify at the official NPI Registry.