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General NPI Number Information
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NPI Number | 1396526331
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Entity Type | Individual
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Provider Name | JENNIFER SUJIN LEE
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Gender | Female
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Dates
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Enumeration Date | 10/05/2023
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Last Update Date | 10/05/2023
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Provider Practice Location Address
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Address Line | 361 HOSPITAL RD STE 422
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-3525
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Country | US
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Telephone | 844-799-7378
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Fax |
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Provider Business Mailing Address
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Address Line | 6 GOLDENBUSH
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City | IRVINE
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State | CA
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Zip | 92604-2839
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Country | US
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Telephone | 847-912-8333
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Fax |
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 88538
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License Number State | CA
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