Healthcare Provider Details

I. General information

NPI: 1063371847
Provider Name (Legal Business Name): MACKENZIE CHUNTING LEE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3201
US

IV. Provider business mailing address

14010 ALTA VISTA AVE
SARATOGA CA
95070-5422
US

V. Phone/Fax

Practice location:
  • Phone: 628-206-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number92824
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: