Provider Demographics
NPI:1366103699
Name:LEE, SHIN AE
Entity type:Individual
Prefix:
First Name:SHIN AE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHINAE
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:27750 SANTA MARGARITA PKWY
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6653
Mailing Address - Country:US
Mailing Address - Phone:949-770-9898
Mailing Address - Fax:949-770-9202
Practice Address - Street 1:27750 SANTA MARGARITA PKWY
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6653
Practice Address - Country:US
Practice Address - Phone:949-770-9898
Practice Address - Fax:949-770-9202
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-08
Last Update Date:2025-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85474183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist