MEDICARE: MRS. CHIN-JANE R 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	RPH40963	CA

General Provider Information

NPI Number	:	1578884664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHIN-JANE R LEE

Provider Business Mailing Address
First Line	:	12491 VALLEY VIEW ST
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92845-2032
Country	:	US
Telephone Number	:	714-894-9230
Fax Number	:

Provider Business Practice Location Address
First Line	:	12491 VALLEY VIEW ST
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92845-2032
Country	:	US
Telephone Number	:	714-894-9230
Fax Number	:

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

Provider Enumeration Date	:	06/13/2010
Last Update Date	:	06/13/2010

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