MEDICARE: DR. MI-JEONG 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	208000000X	Pediatrics Physician	A73179	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568481471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MI-JEONG LEE

Provider Business Mailing Address
First Line	:	2675 W OLYMPIC BLVD
Second Line	:	STE 103
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2880
Country	:	US
Telephone Number	:	213-252-0036
Fax Number	:	213-252-0043

Provider Business Practice Location Address
First Line	:	2675 W OLYMPIC BLVD
Second Line	:	STE 103
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2880
Country	:	US
Telephone Number	:	213-252-0036
Fax Number	:	213-252-0043

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	07/11/2012

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Directions to “ DR. MI-JEONG LEE ” Practice Location

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