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

Jinsoo Lee

Individual provider Physical Therapist · NPI 1720886146

Jinsoo Lee is a Physical Therapist in Private Practice in Fullerton, California. Qualified in 2024, 2 years ago. Practices with Bom Vichae Physical Therapy Professional Corporation, a 3-clinician group and accepts Medicare assignment. Licensed in California.

Years since qualifying
2
Licensed in
CA
In the registry since
2025
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Practice location Address checks out

1401 S Brookhurst Rd Ste 108
Fullerton, CA 92833-4492
Phone: (714) 519-3263
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 307281 (CA)

Record details

NPI number1720886146
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMarch 3, 2025
Last updated in NPPESMarch 3, 2025
Certification dateMarch 3, 2025
Mailing address3125 Rimrock Cir, Fullerton, CA 92833-5525

Medicare enrollment

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

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Bom Vichae Physical Therapy Professional Corporation — 3 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Fullerton