MEDICARE: DR. RICHARD JOONKOO 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	2084P0804X	Child & Adolescent Psychiatry Physician	A72701	CA

General Provider Information

NPI Number	:	1407968068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD JOONKOO LEE M.D.

Provider Business Mailing Address
First Line	:	3125 MYERS ST
Second Line	:	RCDMH CHILDREN'S TREATMENT SERVICES
City	:	RIVERSIDE
State	:	CA
Zip	:	92503-5527
Country	:	US
Telephone Number	:	951-358-4840
Fax Number	:	951-358-4848

Provider Business Practice Location Address
First Line	:	3125 MYERS ST
Second Line	:	RCDMH CHILDREN'S TREATMENT SERVICES
City	:	RIVERSIDE
State	:	CA
Zip	:	92503-5527
Country	:	US
Telephone Number	:	951-358-4840
Fax Number	:	951-358-4848

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	05/08/2014

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