Provider Demographics
NPI:1891505483
Name:LEE, JANE JEEHOON
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:JEEHOON
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 1:5361 RENAISSANCE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-5664
Mailing Address - Country:US
Mailing Address - Phone:619-972-3255
Mailing Address - Fax:
Practice Address - Street 1:5361 RENAISSANCE AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-5664
Practice Address - Country:US
Practice Address - Phone:619-972-3255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program