MEDICARE: JAIHO 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	183500000X	Pharmacist	62316	CA

General Provider Information

NPI Number	:	1376975920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAIHO LEE

Provider Business Mailing Address
First Line	:	3003 W OLYMPIC BLVD
Second Line	:	#101
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-6500
Country	:	US
Telephone Number	:	213-386-3001
Fax Number	:	213-386-1416

Provider Business Practice Location Address
First Line	:	3003 W OLYMPIC BLVD
Second Line	:	#101
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-6500
Country	:	US
Telephone Number	:	213-386-3001
Fax Number	:	213-386-1416

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

Provider Enumeration Date	:	08/06/2013
Last Update Date	:	08/06/2013

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Directions to “ JAIHO LEE ” Practice Location

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