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

Jesse Joseph Licuanan, MD

Individual provider Specialist · NPI 1396795514

Jesse Joseph Licuanan, MD is an Internal Medicine in Lakewood, California. Qualified in 1999, 27 years ago. Practices with Prohealth Partners, a Medical Group, a 234-clinician group, accepts Medicare assignment and offers telehealth. Licensed in California.

Years since qualifying
27
Licensed in
CA
In the registry since
2006
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

3650 S St Ste 403
Lakewood, CA 90712-1504
Phone: (562) 531-0377
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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 · Licence A87633 (CA)
Specialist Taxonomy 174400000X · Licence A-87633 (CA)

Record details

NPI number1396795514
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedMay 10, 2006
Last updated in NPPESJanuary 6, 2023
Certification dateJanuary 6, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyINTERNAL MEDICINE
Also practisesGENERAL PRACTICE
Medical schoolOTHER
Graduated 1999 (27 years in practice)
Group practice Prohealth Partners, A Medical Group — 234 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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