Individual provider Active NPI

John Jyyoon Lee

  • Psychiatric/Mental Health Nurse Practitioner
  • Los Angeles, CA
National Provider Identifier
1841033305
Registry record updated Jun 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
95030505 Issued in CA
Practice address
11301 Wilshire Blvd. Building 402 (Mail Code 10H5)
Los Angeles, CA 90073
Phone
(310) 478-3711
NPI assigned
Jun 13, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 95030505 CA Primary

Addresses

Primary practice location

11301 Wilshire Blvd. Building 402 (Mail Code 10H5)
Los Angeles, CA 90073

Mailing address

11301 Wilshire Blvd. Building 402 (Mail Code 10H5)
Los Angeles, CA 90073

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251226001424 CA Practitioner - Nurse Practitioner 6103312350 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1625 Schrader Blvd
Los Angeles, CA 90028-6213

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Los Angeles LGBT Center CurrentSince Oct 14, 2025 Accepting new patients
Los Angeles LGBT Center CurrentSince Oct 14, 2025 Accepting new patients

Locations

1625 Schrader Blvd
Fl 3
Los Angeles, CA 90028
Phone (323) 993-7400

1625 Schrader Blvd
Los Angeles, CA 90028
Phone (323) 993-7400

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1718236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718236800000",
    "number": "1841033305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11301 WILSHIRE BLVD. BUILDING 402 (MAIL CODE 10H5)",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11301 WILSHIRE BLVD. BUILDING 402 (MAIL CODE 10H5)",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90073",
            "telephone_number": "310-478-3711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "JOHN",
        "middle_name": "JYYOON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-13",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95030505",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.