Provider Demographics
NPI:1386370419
Name:LEE, JEE EUN
Entity type:Individual
Prefix:
First Name:JEE
Middle Name:EUN
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3136 OAKCREST DR
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-2465
Mailing Address - Country:US
Mailing Address - Phone:626-465-8270
Mailing Address - Fax:
Practice Address - Street 1:5832 BEACH BLVD UNIT 209
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-5501
Practice Address - Country:US
Practice Address - Phone:714-676-5541
Practice Address - Fax:714-676-5542
Is Sole Proprietor?:No
Enumeration Date:2022-07-30
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021150363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily