Healthcare Provider Details

I. General information

NPI: 1750143681
Provider Name (Legal Business Name): JIMMY K. LEE, M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2024
Last Update Date: 04/11/2026
Certification Date: 04/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 OCEANO
IRVINE CA
92602-1865
US

IV. Provider business mailing address

139 OCEANO
IRVINE CA
92602-1865
US

V. Phone/Fax

Practice location:
  • Phone: 949-878-3258
  • Fax:
Mailing address:
  • Phone: 949-878-3258
  • Fax: 949-825-5112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JIMMY KYUNG LEE
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 646-342-5546