Healthcare Provider Details

I. General information

NPI: 1669382495
Provider Name (Legal Business Name): JIEUN LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2026
Last Update Date: 09/12/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 FINCH
LAKE FOREST CA
92630-1434
US

IV. Provider business mailing address

43 FINCH
LAKE FOREST CA
92630-1434
US

V. Phone/Fax

Practice location:
  • Phone: 949-870-6833
  • Fax:
Mailing address:
  • Phone: 949-870-6833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number01349783
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: