Active NPI
Yoonjung Lee, DDS
- Periodontics
- Los Angeles, CA
National Provider Identifier
1972050847
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 100554
- Practice address
- 505 S Virgil Ave
#102
Los Angeles, CA 90020-1406 - Phone
- (917) 601-1379
- NPI assigned
- Sep 8, 2016
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 100554 | CA | Primary |
Addresses
Primary practice location
505 S Virgil Ave
#102
Los Angeles, CA 90020-1406
Mailing address
505 S Virgil Ave
#102
Los Angeles, CA 90020-1406
Phone (917) 601-1379
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 |
|---|---|---|---|---|
| I20251021002542 | CA | Order and Referring Only - Dentist | 5597020859 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1473292800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1491177600000",
"number": "1972050847",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "505 S VIRGIL AVE",
"address_2": "#102",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900201406",
"telephone_number": "917-601-1379"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "505 S VIRGIL AVE",
"address_2": "#102",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900201406",
"telephone_number": "917-601-1379"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "YOONJUNG",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-09-08",
"last_updated": "2017-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "CA",
"license": "100554",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Apr 3, 2017; 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.