NPIMap

Individual provider Active NPI

Su Kin Lee, M.D.

  • Internal Medicine Physician
  • San Gabriel, CA
National Provider Identifier
1871510370
Registry record updated Jan 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A48044 Issued in CA
Practice address
1418 S San Gabriel Blvd. , Suite C
San Gabriel, CA 91776
Phone
(626) 293-1988
Fax
(626) 293-3368
NPI assigned
Jul 17, 2006
Last updated
Jan 11, 2011By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 11, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A48044 CA Primary

Addresses

Primary practice location

1418 S San Gabriel Blvd. , Suite C
San Gabriel, CA 91776

Mailing address

1418 S San Gabriel Blvd. , Suite C
San Gabriel, CA 91776-3726
Phone (626) 293-1988

Other identifiers 1

IdentifierTypeStateIssuer
00A480441MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120223000430 CA Practitioner - Internal Medicine 8224162581 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Duke University School of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
TL Health Care FoundationGroup PAC ID 0446622120, 4 clinicians

Practice addresses (Care Compare)

1418 S San Gabriel Blvd
Suite B
San Gabriel, CA 91776-4605
Phone (626) 293-1988

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A48044CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
S. K. Medical Group Inc. CurrentSince Jul 1, 1994 Accepting new patients
TL Health Care Foundation Internal Medicine CurrentSince Mar 29, 2016 Accepting new patients
Ahmc San Gabriel Valley Medical Past Accepting new patients
Ahmc Garfield Medical Center LP Past Accepting new patients
Alhambra Hospital Medical Center, LP Past Accepting new patients

Locations

1418 S San Gabriel Blvd
Ste B
San Gabriel, CA 91776
Phone (626) 293-1988

1418 S San Gabriel Blvd
Ste C
San Gabriel, CA 91776
Phone (626) 293-1988

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/HBFADD/Endpoint/HBFADD

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Sunny Village Care CenterAlhambra, CA, CCN 055203 Skilled nursing facility 5% Or Greater Direct Ownership Interest (9.6%)
Direct Ownership Interest		 Oct 15, 2010
Oct 15, 2010
TL Health Care FoundationSan Gabriel, CA, CCN A01969 Federally qualified health center 5% Or Greater Direct Ownership Interest
Corporate Officer (80%)
W-2 Managing Employee (20%)		 Aug 1, 2024
Aug 1, 2024
Aug 1, 2024

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

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

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294704000000",
    "number": "1871510370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1418 S SAN GABRIEL BLVD. , SUITE C",
            "city": "SAN GABRIEL",
            "state": "CA",
            "postal_code": "917763726",
            "telephone_number": "626-293-1988",
            "fax_number": "626-293-3368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1418 S SAN GABRIEL BLVD. , SUITE C",
            "city": "SAN GABRIEL",
            "state": "CA",
            "postal_code": "91776",
            "telephone_number": "626-293-1988",
            "fax_number": "626-293-3368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "SU",
        "middle_name": "KIN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2011-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A48044",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A480441",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Gabriel, CA

Sources for this page

Verify at the official NPI Registry.