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General NPI Number Information
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NPI Number | 1366076580
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Entity Type | Individual
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Provider Name | DANIEL GUNJOO LEE
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Gender | Male
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Dates
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Enumeration Date | 02/26/2020
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Last Update Date | 02/02/2025
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Provider Practice Location Address
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Address Line | 9500 GILMAN DR
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City | LA JOLLA
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State | CA
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Zip | 92093-4504
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Country | US
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Telephone | 210-292-7805
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Fax |
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Provider Business Mailing Address
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Address Line | 3551 ROGER BROOKE DR
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City | JBSA FT SAM HOUSTON
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State | TX
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Zip | 78234-4504
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Country | US
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Telephone | 210-292-7805
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Fax | 210-292-7868
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 20A22164
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License Number State | CA
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