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General NPI Number Information
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NPI Number | 1043617939
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Entity Type | Organization
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Legal Business Name | JI YON LEE MD, INC
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Dates
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Enumeration Date | 11/21/2014
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Last Update Date | 04/25/2023
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Provider Practice Location Address
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Address Line | 4902 IRVINE CENTER DR STE 102
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City | IRVINE
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State | CA
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Zip | 92604-3334
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Country | US
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Telephone | 949-757-3690
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Fax | 949-596-9146
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Provider Business Mailing Address
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Address Line | 4902 IRVINE CENTER DR STE 102
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City | IRVINE
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State | CA
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Zip | 92604-3334
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Country | US
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Telephone | 949-757-3690
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Fax | 949-596-9146
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Authorized Official
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Title or Position | CEO
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Name | JI YON HAN
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Credential | MD
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Telephone | 949-757-3690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A108338
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License Number State | CA
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