MEDICARE: HEESUNG DAVID 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	89626	CA

General Provider Information

NPI Number	:	1578391348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEESUNG DAVID LEE

Provider Business Mailing Address
First Line	:	3064 N SCHNEIDER AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93737-9287
Country	:	US
Telephone Number	:	714-824-1241
Fax Number	:

Provider Business Practice Location Address
First Line	:	402 S MADERA AVE STE A
Second Line	:
City	:	MADERA
State	:	CA
Zip	:	93637-3203
Country	:	US
Telephone Number	:	559-674-8553
Fax Number	:

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

Provider Enumeration Date	:	07/23/2024
Last Update Date	:	07/23/2024

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Directions to “ HEESUNG DAVID LEE ” Practice Location

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