Healthcare Provider Details

I. General information

NPI: 1285414367
Provider Name (Legal Business Name): JESSICA YVETTE LEE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2023
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5823 YORK BLVD STE 1
LOS ANGELES CA
90042-2634
US

IV. Provider business mailing address

5823 YORK BLVD STE 1
LOS ANGELES CA
90042-2634
US

V. Phone/Fax

Practice location:
  • Phone: 323-255-1575
  • Fax: 323-255-8139
Mailing address:
  • Phone: 323-255-1575
  • Fax: 323-255-8139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number65111
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: