Individual provider Active NPI

Ellen Kyungchae Lee, PA

  • Physician Assistant
  • Santa Monica, CA
National Provider Identifier
1962046714
Registry record updated Oct 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
2221 Lincoln Blvd Ste 100
Santa Monica, CA 90405-1320
Phone
(310) 392-1111
Fax
(310) 392-1101
NPI assigned
Nov 5, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

2221 Lincoln Blvd Ste 100
Santa Monica, CA 90405-1320

Mailing address

2221 Lincoln Blvd Ste 100
Santa Monica, CA 90405-1320
Phone (310) 392-1111

Other practice location 1

9090 Burton Way
Beverly Hills, CA 90211-1661
Phone (310) 392-1111

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
I20201123001140 CA Practitioner - Physician Assistant 9335550383 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Daniel Behroozan MD a Medical CorporationGroup PAC ID 2769482447, 5 clinicians

Practice addresses (Care Compare)

2221 Lincoln Blvd
Suite 100
Santa Monica, CA 90405-1320
Phone (310) 392-1111

Merit-based Incentive Payment System (MIPS)

Final score
82.92 of 100Reported as group
Quality
86.59
Promoting interoperability
100
Improvement activities
40
Cost
56.47

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Interoperability endpoints

  • Direct secure messaging: el@dermsouthcal.emadirect.md

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": "1572912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760918400000",
    "number": "1962046714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2221 LINCOLN BLVD STE 100",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904051320",
            "telephone_number": "310-392-1111",
            "fax_number": "310-392-1101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2221 LINCOLN BLVD STE 100",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904051320",
            "telephone_number": "310-392-1111",
            "fax_number": "310-392-1101"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9090 Burton Way",
            "address_purpose": "LOCATION",
            "city": "Beverly Hills",
            "state": "CA",
            "postal_code": "902111661",
            "country_code": "US",
            "telephone_number": "310-392-1111",
            "fax_number": "310-392-1110",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEE",
        "first_name": "ELLEN",
        "middle_name": "KYUNGCHAE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-05",
        "last_updated": "2025-10-20",
        "certification_date": "2025-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Monica, CA

Sources for this page

Verify at the official NPI Registry.