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SAMUEL K. LEE, M.D., INC.
NPI 1164734158
Urology in Los Angeles, CA

Active since July 08, 2010CLIA 05D1001720 · Microscopy
201 S ALVARADO ST, SUITE 622, LOS ANGELES, CA 90057(213) 413-2622(213) 413-2922 Get Directions Write a Review

NPPES record last updated: July 8, 2010. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Samuel K. Lee, M.d., Inc. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SAMUEL K. LEE, M.D., INC. (NPI 1164734158) is a healthcare organization registered as an urology in Los Angeles, California and active in the NPI registry since July 2010. The organization holds a CLIA Microscopy certificate valid through February 17, 2028 and lists Samuel K. Lee, President, as its authorized official.

NPPES Registry Identity

NPI1164734158
Entity TypeOrganization
Primary Taxonomy208800000X
Legal Business NameSAMUEL K. LEE, M.D., INC.
Location Address201 S ALVARADO ST, SUITE 622Los Angeles, CA 90057-2320
Mailing AddressP.o. Box 1105La Canada, CA 91012-1105 · (213) 413-2622 · Fax (213) 413-2922
Phone(213) 413-2622
Fax(213) 413-2922
Organization SubpartNo
Authorized OfficialSamuel K. LeePresident · (213) 413-2622
Enumeration DateJuly 8, 2010
✔ NPI 1164734158 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyUrologyAllopathic & Osteopathic Physicians
Taxonomy Code208800000X
License✔ Licensed in CA · G070695
Definition
A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures.
201 S ALVARADO ST, Los Angeles, CA 90057
Open in Google Maps ↗

Other Identifiers 1

OtherG070695CA · California State Licence

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Samuel K. Lee, M.d., Inc. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by October 31, 2026

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date
StateCaliforniaEnrollment IDO20110223000625Non-DME Part B · Clinic/Group PracticeDue dateOctober 31, 2026
Source: CMS Revalidation Due Date List, October 2026 release.

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Samuel K. Lee, M.D., Inc., which bills Medicare for the services they deliver. Of these, 1 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (2)

Samuel Lee, M.D.
Urology
NPI 1922023043
201 S ALVARADO ST SUITE 622
Los Angeles, CA 90057
(213) 413-2622
✔ PECOS✔ Accepts Medicare0.3 mi
Jayson Jun, MSN, FNP-C, PMHNP-BC
Nurse Practitioner
NPI 1760808240
18700 MAIN ST STE 108
Huntington Beach, CA 92648
(949) 424-5224
✔ PECOS✔ Accepts Medicare31 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 05D1001720

Samuel K Lee MD Inc · Los Angeles, CA
Active · expires Feb 17, 2028
CLIA Number05D1001720
Laboratory TypePhysician Office
Certificate Effective DateFebruary 18, 2026
Certificate Expiration DateFebruary 17, 2028
Laboratory DirectorSamuel K. Lee MD
Laboratory Phone(213) 413-2622
Laboratory LocationSamuel K Lee MD Inc266 S Harvard Blvd Ste 366, Los Angeles, CA 90004
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Samuel K. Lee, M.D., Inc.'s NPI number?

The NPI number for Samuel K. Lee, M.D., Inc. is 1164734158. It was assigned to this organization in the NPPES registry on July 8, 2010.

Where is Samuel K. Lee, M.D., Inc. located?

Samuel K. Lee, M.D., Inc. is located at 201 S Alvarado St Suite 622, Los Angeles, CA 90057. The listed phone number is (213) 413-2622.

What is Samuel K. Lee, M.D., Inc.'s specialty?

The primary specialty registered for this NPI is Urology with taxonomy code 208800000X.

Is Samuel K. Lee, M.D., Inc. enrolled in Medicare?

Yes. Samuel K. Lee, M.D., Inc. is registered in the Medicare PECOS enrollment system.

When is Samuel K. Lee, M.D., Inc.'s Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (California, Clinic/Group Practice) is due for revalidation by October 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

How many clinicians bill Medicare through Samuel K. Lee, M.D., Inc.?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Samuel K. Lee, M.D., Inc., in Nurse Practitioner and Urology. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Samuel K. Lee, M.D., Inc. hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 05D1001720) is associated with this NPI, valid through February 17, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Samuel K. Lee, M.D., Inc. was last updated on July 8, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.