MEDICARE: HYUNJU LEE M.D.

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	A146630	CA
2	207R00000X	Internal Medicine Physician	260347	MA

General Provider Information

NPI Number	:	1629483102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HYUNJU LEE M.D.

Provider Business Mailing Address
First Line	:	12372 GARDEN GROVE BLVD STE B
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-1805
Country	:	US
Telephone Number	:	714-583-8569
Fax Number	:	714-661-5371

Provider Business Practice Location Address
First Line	:	12372 GARDEN GROVE BLVD STE B
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-1805
Country	:	US
Telephone Number	:	714-583-8569
Fax Number	:	714-661-5371

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

Provider Enumeration Date	:	06/24/2014
Last Update Date	:	02/05/2026

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