Active NPI
Jisu Lee
- Acupuncturist
- San Pedro, CA
National Provider Identifier
1740884758
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- AC18969
- Practice address
- 505 S Pacific Ave Unit 103
San Pedro, CA 90731-2656 - Phone
- (310) 935-2182
- NPI assigned
- Nov 30, 2020
- Last updated
- Nov 30, 2020
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Acupuncturist | 171100000X | AC18969 | CA | Primary |
Addresses
Primary practice location
505 S Pacific Ave Unit 103
San Pedro, CA 90731-2656
Mailing address
719 Orange Grove Ave Apt 203
Glendale, CA 91205-1789
Phone (626) 808-7075
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AC18969 | CA | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1606694400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606694400000",
"number": "1740884758",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "719 ORANGE GROVE AVE APT 203",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912051789",
"telephone_number": "626-808-7075"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "505 S PACIFIC AVE UNIT 103",
"city": "SAN PEDRO",
"state": "CA",
"postal_code": "907312656",
"telephone_number": "310-935-2182"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "JISU",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-11-30",
"last_updated": "2020-11-30",
"certification_date": "2020-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "CA",
"license": "AC18969",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Pedro, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.