Active NPI
Jin Y Lee, MD
- Surgery Physician
- San Jose, CA
National Provider Identifier
1891890570
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- A42438
- Practice address
- 100 Oconnor Dr
#12
San Jose, CA 95128 - Phone
- (408) 280-5655
- Fax
- (408) 280-5631
- NPI assigned
- Sep 14, 2006
- 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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | A42438 | CA | Primary |
Addresses
Primary practice location
100 Oconnor Dr
#12
San Jose, CA 95128
Mailing address
100 Oconnor Dr
#12
San Jose, CA 95128
Phone (408) 280-5655
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A424380 | Medicaid | CA |
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: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110315000408 | CA | Practitioner - General Surgery | 7517149339 | Practice locations: San Jose, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 42438 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1891890570",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 OCONNOR DR",
"address_2": "#12",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "95128",
"telephone_number": "408-280-5655",
"fax_number": "408-280-5631"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 OCONNOR DR",
"address_2": "#12",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "95128",
"telephone_number": "408-280-5655",
"fax_number": "408-280-5631"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "JIN",
"middle_name": "Y",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "CA",
"license": "A42438",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00A424380",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.