Healthcare Provider Details

I. General information

NPI: 1487601928
Provider Name (Legal Business Name): JAMES LEE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 12/13/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3201
US

IV. Provider business mailing address

PO BOX 54840
LOS ANGELES CA
90054-0840
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-8068
  • Fax: 714-456-3765
Mailing address:
  • Phone: 714-456-8068
  • Fax: 714-456-3765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA16266
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA16266
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA16266
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: