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NPI Code Detail

MEDICARE: JIYOUN LEE

MEDICARE: JIYOUN LEE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor

General Provider Information

NPI Number : 1235225715
Entity Type Code : Individual
Provider Name (Legal Business Name) : JIYOUN LEE
Provider Business Mailing Address
First Line : 1050 S BROOKHURST RD
Second Line :
City : FULLERTON
State : CA
Zip : 92833-3709
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1050 S BROOKHURST RD
Second Line :
City : FULLERTON
State : CA
Zip : 92833-3709
Country : US
Telephone Number : 714-449-1125
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2006
Last Update Date : 07/08/2007

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Directions to “ JIYOUN LEE ” Practice Location

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