Angelina Lee Jedlicka, PT

Primary specialty

SpecialistTaxonomy code 174400000X

License

PT11250 Issued in CA

Practice address

1336 N Edgemont St
Los Angeles, CA 90027-5912

Phone

(323) 783-5499

NPI assigned

Jun 28, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1182988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638316800000",
    "number": "1730386129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3314 DURHAM CT",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915041600",
            "telephone_number": "818-953-5157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1336 N EDGEMONT ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900275912",
            "telephone_number": "323-783-5499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEDLICKA",
        "first_name": "ANGELINA",
        "middle_name": "LEE",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-28",
        "last_updated": "2021-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "PT11250",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICAL THERAPIST",
            "identifier": "PT11250",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4733 W Sunset Blvd",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900276021",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Brieyhanna-Marie Jewel Jeanty
• Jens Nicholas Jebsen, AMFT
• Suzanne L Jed, MSN, APRN-BC
• Shannon Jeddi, M.S.
• Miri Jedeikin, LMFT
• Meaghan Marianna Jedrzejewski Tovar, PSYD
• Jee Healthcare
• Euibin Jee
• Sang Hyun Jee
• Jeff Steinberg MD

• Specialist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 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.