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General NPI Number Information
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NPI Number | 1891456885
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Entity Type | Individual
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Provider Name | JISOO LEE PA
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Gender | Female
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Dates
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Enumeration Date | 01/03/2022
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 16405 SAND CANYON AVE STE 265
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City | IRVINE
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State | CA
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Zip | 92618-3792
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Country | US
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Telephone | 714-602-9891
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Fax | 714-912-4181
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Provider Business Mailing Address
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Address Line | 16405 SAND CANYON AVE STE 265
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City | IRVINE
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State | CA
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Zip | 92618-3792
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Country | US
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Telephone | 714-602-9891
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Fax | 714-912-4181
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA60693
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License Number State | CA
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