Healthcare Provider Details

I. General information

NPI: 1295050508
Provider Name (Legal Business Name): MIN JUNG LEE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 NEWPORT CENTER DR STE 401
NEWPORT BEACH CA
92660-7688
US

IV. Provider business mailing address

400 NEWPORT CENTER DR STE 401
NEWPORT BEACH CA
92660-7688
US

V. Phone/Fax

Practice location:
  • Phone: 949-791-3202
  • Fax: 949-791-3081
Mailing address:
  • Phone: 949-791-3202
  • Fax: 949-791-3081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberC167412
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License NumberC167412
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: