NPIMap

Organization Active NPI

Innovative Medicine

  • Physical Therapist
  • Los Angeles, CA
National Provider Identifier
1821494014
Registry record updated Nov 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT40619 Issued in CA
Legal business name
INNOVATIVE MEDICINE
Practice address
811 Wilshire Blvd
Suite 110
Los Angeles, CA 90017-2606
Phone
(213) 415-1990
Fax
(213) 415-1940
NPI assigned
Nov 14, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2014

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

Authorized official

Name
Dr. TSZ Ying Lee, M.D.
Title
Medical Director
Phone
(231) 415-1990

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X A99205 CA
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X PT40619 CA Primary

Addresses

Primary practice location

811 Wilshire Blvd
Suite 110
Los Angeles, CA 90017-2606

Mailing address

811 Wilshire Blvd
Suite 110
Los Angeles, CA 90017-2606
Phone (213) 415-1990

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1415923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415923200000",
    "number": "1821494014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 WILSHIRE BLVD",
            "address_2": "SUITE 110",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900172606",
            "telephone_number": "213-415-1990",
            "fax_number": "213-415-1940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 WILSHIRE BLVD",
            "address_2": "SUITE 110",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900172606",
            "telephone_number": "213-415-1990",
            "fax_number": "213-415-1940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-14",
        "last_updated": "2014-11-14",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "TSZ",
        "authorized_official_middle_name": "YING",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "231-415-1990",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A99205",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT40619",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2014; 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.