MIRAE MEDICAL CLINIC
NPI 1407267586
Internal Medicine in Los Angeles, CA
About Mirae Medical Clinic NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MIRAE MEDICAL CLINIC (NPI 1407267586) is a healthcare organization registered as an internal medicine in Los Angeles, California and active in the NPI registry since May 2014. The organization holds a CLIA Waiver certificate valid through August 16, 2028 and lists Hee Soo Jeong, President, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Other Identifiers 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Mirae Medical Clinic is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Mirae Medical Clinic, which bills Medicare for the services this clinician delivers.
Clinician (1)
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 of Waiver 05D2045637
Mirae Medical Clinic · Los Angeles, CAFrequently 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 Hee Soo Jeong MD A Professional Medical Corporation's NPI number?
The NPI number for Hee Soo Jeong MD A Professional Medical Corporation is 1407267586. It was assigned to this organization in the NPPES registry on May 12, 2014. The provider is doing business as Mirae Medical Clinic.
Where is Hee Soo Jeong MD A Professional Medical Corporation located?
Hee Soo Jeong MD A Professional Medical Corporation is located at 2675 W Olympic Blvd Suite 202, Los Angeles, CA 90006. The listed phone number is (213) 387-1541.
What is Hee Soo Jeong MD A Professional Medical Corporation's specialty?
The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.
Is Hee Soo Jeong MD A Professional Medical Corporation enrolled in Medicare?
Yes. Hee Soo Jeong MD A Professional Medical Corporation is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Hee Soo Jeong MD A Professional Medical Corporation?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Internal Medicine) reassigns their Medicare billing to Hee Soo Jeong MD A Professional Medical Corporation. 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Hee Soo Jeong MD A Professional Medical Corporation hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 05D2045637) is associated with this NPI, valid through August 16, 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 Hee Soo Jeong MD A Professional Medical Corporation was last updated on May 12, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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.
# Mirae Medical Clinic · NPI 1407267586
Internal Medicine organization in Los Angeles, California. Organization record, active in the CMS NPPES registry since May 12, 2014.
## Identity
- **NPI:** 1407267586 (Entity type: Organization)
- **Enumerated:** May 12, 2014
- **Primary specialty:** Internal Medicine · taxonomy 207R00000X
- **Legal business name:** Hee Soo Jeong Md A Professional Medical Corporation
- **Organization subpart:** No
- **Authorized official:** Hee Soo Jeong, PRESIDENT
## Practice location
- **Address:** 2675 W OLYMPIC BLVD, SUITE 202, Los Angeles, CA 90006-2880
- **Phone:** (213) 387-1541 · **Fax:** (866) 531-4907
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Internal Medicine) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** May 12, 2014
- **Other identifiers:** Other A105825 (CA)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1407267586) · Data from the CMS NPPES public registry.