MEDICARE: IRENE J LEE PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	66946	CA
2	363A00000X	Physician Assistant	66946	CA

General Provider Information

NPI Number	:	1003778846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRENE J LEE PA

Provider Business Mailing Address
First Line	:	2625 E DIVISADERO ST
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93721-1431
Country	:	US
Telephone Number	:	559-443-2682
Fax Number	:	559-443-2681

Provider Business Practice Location Address
First Line	:	7085 N CHESTNUT AVE STE 101
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93720-0353
Country	:	US
Telephone Number	:	559-323-9236
Fax Number	:	559-323-0294

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	01/19/2026

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Directions to “ IRENE J LEE PA” Practice Location

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