MEDICARE: MRS. JENNIFER KIM LEE

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	174400000X	Specialist	A81453	CA

General Provider Information

NPI Number	:	1174571491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER KIM LEE

Provider Business Mailing Address
First Line	:	7 IROQUOIS CT
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92602-0752
Country	:	US
Telephone Number	:	310-903-6615
Fax Number	:

Provider Business Practice Location Address
First Line	:	3430 E LA PALMA AVE
Second Line	:	MOB 2 OBGYN
City	:	ANAHEIM
State	:	CA
Zip	:	92806-2020
Country	:	US
Telephone Number	:	714-644-2560
Fax Number	:

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	03/07/2023

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