Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jesse J Licuanan MD a Medical Corporation

Organization Internal Medicine Physician · NPI 1114218559

Jesse J Licuanan MD a Medical Corporation is an Internal Medicine Physician in Lakewood, California. Registered with an NPI since 2011.

In the registry since
2011

Practice location Address checks out

3300 E South St Ste 205
Lakewood, CA 90805-4549
Phone: (562) 531-0377
Fax: (562) 531-1724
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X

Record details

NPI number1114218559
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jesse Licuanan — President/Owner · (562) 531-0377
NPI enumeratedApril 19, 2011
Last updated in NPPESApril 19, 2011
Mailing address8251 La Palma Ave, Suite 434, Buena Park, CA 90620-3205

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