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General NPI Number Information
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NPI Number | 1891658043
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Entity Type | Individual
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Provider Name | JEONG SU LEE
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Gender | Female
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Dates
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Enumeration Date | 12/04/2025
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 5821 BEACH BLVD STE 101
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City | BUENA PARK
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State | CA
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Zip | 90621-2021
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Country | US
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Telephone | 714-752-6223
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Fax |
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Provider Business Mailing Address
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Address Line | 1901 E DYER RD UNIT 537
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City | SANTA ANA
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State | CA
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Zip | 92705-5799
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Country | US
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Telephone |
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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 | 91450
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License Number State | CA
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