MEDICARE: JOVONNE 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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1952084410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOVONNE LEE

Provider Business Mailing Address
First Line	:	301 E JEANETTE LN UNIT 211
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-6028
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2575 YORBA LINDA BLVD
Second Line	:
City	:	FULLERTON
State	:	CA
Zip	:	92831-1615
Country	:	US
Telephone Number	:	714-449-7400
Fax Number	:

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

Provider Enumeration Date	:	08/10/2023
Last Update Date	:	12/06/2025

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Directions to “ JOVONNE LEE ” Practice Location

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