Provider Demographics
NPI:1285414367
Name:LEE, JESSICA YVETTE (PA-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:YVETTE
Last Name:LEE
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5823 YORK BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-2634
Mailing Address - Country:US
Mailing Address - Phone:323-255-1575
Mailing Address - Fax:323-255-8139
Practice Address - Street 1:5823 YORK BLVD STE 1
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042-2634
Practice Address - Country:US
Practice Address - Phone:323-255-1575
Practice Address - Fax:323-255-8139
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-05
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65111363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant