Healthcare Provider Details

I. General information

NPI: 1679391866
Provider Name (Legal Business Name): JOANNE JU-EUN LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2024
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1664 BROADWAY
EL CAJON CA
92021-5201
US

IV. Provider business mailing address

1664 BROADWAY
EL CAJON CA
92021-5201
US

V. Phone/Fax

Practice location:
  • Phone: 619-579-8685
  • Fax: 619-579-1969
Mailing address:
  • Phone: 619-579-8685
  • Fax: 619-579-1969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: