Healthcare Provider Details

I. General information

NPI: 1437969334
Provider Name (Legal Business Name): JAE HONG LEE MD, MPH, JD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 01/13/2025
Certification Date: 01/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15081 ALMOND ORCHARD LN
SAN DIEGO CA
92131-4329
US

IV. Provider business mailing address

15081 ALMOND ORCHARD LN
SAN DIEGO CA
92131-4329
US

V. Phone/Fax

Practice location:
  • Phone: 510-219-3860
  • Fax:
Mailing address:
  • Phone: 510-219-3860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberG81426
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: