MEDICARE: JONG D LEE M.D.

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	207Q00000X	Family Medicine Physician	C39144	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C39144	OTHER	CA	STATE LICENSE

General Provider Information

NPI Number	:	1023259819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONG D LEE M.D.

Provider Business Mailing Address
First Line	:	9828 GARDEN GROVE BLVD STE 201
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92844-1659
Country	:	US
Telephone Number	:	714-530-9633
Fax Number	:	714-530-4410

Provider Business Practice Location Address
First Line	:	9828 GARDEN GROVE BLVD STE 201
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92844-1659
Country	:	US
Telephone Number	:	714-530-9633
Fax Number	:	714-530-4410

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

Provider Enumeration Date	:	03/09/2009
Last Update Date	:	03/09/2009

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Directions to “ JONG D LEE M.D.” Practice Location

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