Individual provider Active NPI

Jonathan Joonhyung Lee, DDS

  • Dentist
  • Lake Elsinore, CA
National Provider Identifier
1861384588
Registry record updated Jul 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
111863 Issued in CA
Practice address
29273 Central Ave Ste a
Lake Elsinore, CA 92532-2254
Phone
(951) 245-8664
NPI assigned
Jul 17, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 111863 CA Primary

Addresses

Primary practice location

29273 Central Ave Ste a
Lake Elsinore, CA 92532-2254

Mailing address

27000 W Lugonia Ave Apt 12109
Redlands, CA 92374-2097
Phone (909) 583-5984

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250925001937 CA Order and Referring Only - DentistPractitioner - Dentist 5991200487

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
111863CAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Watanabe and Lynn Dental Corporation PastSince Jul 22, 2025 Accepting new patients

Organizations & group practices 1

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": "1752710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752710400000",
    "number": "1861384588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27000 W LUGONIA AVE APT 12109",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923742097",
            "telephone_number": "909-583-5984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29273 CENTRAL AVE STE A",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925322254",
            "telephone_number": "951-245-8664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "JONATHAN",
        "middle_name": "JOONHYUNG",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-07-17",
        "last_updated": "2025-07-17",
        "certification_date": "2025-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "111863",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Elsinore, CA

Sources for this page

Verify at the official NPI Registry.