Active NPI
Shannon Jinho Lee
- Pediatrics Physician
- Culver City, CA
National Provider Identifier
1710538616
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 5504
- Practice address
- 5901 Green Valley Cir Ste 130
Culver City, CA 90230-6900 - Phone
- (818) 788-1003
- NPI assigned
- Sep 23, 2019
- Last updated
- Sep 23, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 5504 | CA | Primary |
Addresses
Primary practice location
5901 Green Valley Cir Ste 130
Culver City, CA 90230-6900
Mailing address
16500 Ventura Blvd Ste 414
Encino, CA 91436-5050
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1569196800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1569196800000",
"number": "1710538616",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16500 VENTURA BLVD STE 414",
"city": "ENCINO",
"state": "CA",
"postal_code": "914365050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5901 GREEN VALLEY CIR STE 130",
"city": "CULVER CITY",
"state": "CA",
"postal_code": "902306900",
"telephone_number": "818-788-1003"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "SHANNON",
"middle_name": "JINHO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-09-23",
"last_updated": "2019-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "5504",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Culver City, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.