MEDICARE: HEEJIN 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
1	183500000X	Pharmacist	68660	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	68660	OTHER	CA	183500000X

General Provider Information

NPI Number	:	1558602581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEEJIN LEE

Provider Business Mailing Address
First Line	:	38451 5TH ST W APT A7
Second Line	:
City	:	PALMDALE
State	:	CA
Zip	:	93551
Country	:	US
Telephone Number	:	319-321-7862
Fax Number	:

Provider Business Practice Location Address
First Line	:	9482 CALIFORNIA CITY BLVD
Second Line	:
City	:	CALIFORNIA CITY
State	:	CA
Zip	:	93505
Country	:	US
Telephone Number	:	760-373-5268
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2013
Last Update Date	:	03/15/2013

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Directions to “ HEEJIN LEE ” Practice Location

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