Healthcare Provider Details

I. General information

NPI: 1003778846
Provider Name (Legal Business Name): IRENE LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7085 N CHESTNUT AVE STE 101
FRESNO CA
93720-0353
US

IV. Provider business mailing address

7509 N WILLOW AVE STE 101
FRESNO CA
93720-0345
US

V. Phone/Fax

Practice location:
  • Phone: 559-323-9236
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberPA66946
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: