MEDICARE: JIN YONG 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	363LF0000X	Family Nurse Practitioner	95016232	CA
2	363L00000X	Nurse Practitioner	95016232	CA
3	207RH0003X	Hematology & Oncology Physician	95016232	CA

General Provider Information

NPI Number	:	1699439356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIN YONG LEE

Provider Business Mailing Address
First Line	:	5767 W CENTURY BLVD STE 400
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-5631
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 UCLA MEDICAL PLZ STE 120
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-0001
Country	:	US
Telephone Number	:	310-206-6909
Fax Number	:	310-206-5507

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

Provider Enumeration Date	:	10/28/2021
Last Update Date	:	02/03/2026

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Directions to “ JIN YONG LEE ” Practice Location

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