Healthcare Provider Details

I. General information

NPI: 1104927615
Provider Name (Legal Business Name): JOSELYN CARMEL LEE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3740 ATLANTIC AVE STE 100
LONG BEACH CA
90807-3440
US

IV. Provider business mailing address

PO BOX 24854
LOS ANGELES CA
90024-0854
US

V. Phone/Fax

Practice location:
  • Phone: 310-869-8590
  • Fax: 310-479-3147
Mailing address:
  • Phone: 310-479-3147
  • Fax: 310-479-3147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberG071856
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: