Healthcare Provider Details

I. General information

NPI: 1396684155
Provider Name (Legal Business Name): SUNGEUN LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22942 RIDGE ROUTE DR STE 104
LAKE FOREST CA
92630-3693
US

IV. Provider business mailing address

22942 RIDGE ROUTE DR STE 104
LAKE FOREST CA
92630-3693
US

V. Phone/Fax

Practice location:
  • Phone: 949-215-5899
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number91799
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: