Active NPI
Alexander Wooram Scott Shin Lee, D.D.S.
- Pediatric Dentistry
- Los Angeles, CA
National Provider Identifier
1851784268
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 65362
- Practice address
- 2010 Zonal Ave. BLDG. B,
#5P77
Los Angeles, CA 90033 - Phone
- (215) 834-2709
- NPI assigned
- Mar 9, 2015
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 65362 | CA | Primary |
Addresses
Primary practice location
2010 Zonal Ave. BLDG. B,
#5P77
Los Angeles, CA 90033
Mailing address
2010 Zonal Ave, Building B
5P77
Los Angeles, CA 90033-1987
Phone (215) 834-2709
Other names 1
- Dr. Woo Ram Lee
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: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161024002063 | CA | Order and Referring Only - Other (Physician) | 4789962853 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 65362 | CA | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1425859200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1634774400000",
"number": "1851784268",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2010 ZONAL AVE, BUILDING B",
"address_2": "5P77",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900331987",
"telephone_number": "215-834-2709"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2010 ZONAL AVE. BLDG. B,",
"address_2": "#5P77",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90033",
"telephone_number": "215-834-2709"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "ALEXANDER",
"middle_name": "WOORAM SCOTT SHIN",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-03-09",
"last_updated": "2021-10-21",
"certification_date": "2021-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "CA",
"license": "65362",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "WOO RAM",
"last_name": "LEE",
"prefix": "DR.",
"code": "1",
"type": "Former Name"
}
]
}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 Oct 21, 2021; 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.