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NPI Code Detail

MEDICARE: DR. JAY WON LEE MD, MPH

MEDICARE: DR. JAY WON LEE MD, MPH
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
1207Q00000XFamily Medicine PhysicianA84879CA

General Provider Information

NPI Number : 1548201726
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAY WON LEE MD, MPH
Provider Business Mailing Address
First Line : PO BOX 10159
Second Line :
City : COSTA MESA
State : CA
Zip : 92627-0050
Country : US
Telephone Number : 949-270-2100
Fax Number : 949-650-4458
Provider Business Practice Location Address
First Line : 1550 SUPERIOR AVE
Second Line :
City : COSTA MESA
State : CA
Zip : 92627-3653
Country : US
Telephone Number : 949-270-2100
Fax Number : 949-650-4458
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2006
Last Update Date : 09/24/2020

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