MEDICARE: EUNICE JAEUN 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	208000000X	Pediatrics Physician	43667	AZ
2	208000000X	Pediatrics Physician	A103616	CA

General Provider Information

NPI Number	:	1235344607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUNICE JAEUN LEE M.D.

Provider Business Mailing Address
First Line	:	495 E RINCON ST STE 215
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92879-1378
Country	:	US
Telephone Number	:	951-354-3221
Fax Number	:

Provider Business Practice Location Address
First Line	:	9675 MONTE VISTA AVE STE C
Second Line	:
City	:	MONTCLAIR
State	:	CA
Zip	:	91763-2213
Country	:	US
Telephone Number	:	855-505-7467
Fax Number	:	888-975-8926

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

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	06/21/2023

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