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General NPI Number Information
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NPI Number | 1952004095
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Entity Type | Individual
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Provider Name | JAE YOUNG LEE
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Gender | Female
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Dates
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Enumeration Date | 03/27/2023
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Last Update Date | 11/24/2023
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Provider Practice Location Address
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Address Line | 15095 AMARGOSA RD STE 102
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City | VICTORVILLE
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State | CA
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Zip | 92394-1875
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Country | US
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Telephone | 760-552-4470
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Fax |
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Provider Business Mailing Address
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Address Line | 7425 S 9TH ST. #119
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City | BUENA PARK
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State | CA
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Zip | 90621-7425
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Country | US
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Telephone | 425-243-7085
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP95024373
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License Number State | CA
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