Active NPI
Sang Jin Lee, LCSW
- Clinical Social Worker
- Gardena, CA
National Provider Identifier
1801629498
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 123952
- Practice address
- 15817 La Salle Ave
Gardena, CA 90247-3725 - Phone
- (310) 422-2423
- NPI assigned
- Aug 21, 2024
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 123952 | CA | Primary |
Addresses
Primary practice location
15817 La Salle Ave
Gardena, CA 90247-3725
Mailing address
15817 La Salle Ave
Gardena, CA 90247-3725
Phone (310) 422-2423
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1724198400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724198400000",
"number": "1801629498",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15817 LA SALLE AVE",
"city": "GARDENA",
"state": "CA",
"postal_code": "902473725",
"telephone_number": "310-422-2423"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15817 LA SALLE AVE",
"city": "GARDENA",
"state": "CA",
"postal_code": "902473725",
"telephone_number": "310-422-2423"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "SANG",
"middle_name": "JIN",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-08-21",
"last_updated": "2024-08-21",
"certification_date": "2024-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "123952",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gardena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.