MEDICARE: JAWCHYI LEE MD

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	207P00000X	Emergency Medicine Physician	2026021113	MO
2	207P00000X	Emergency Medicine Physician	76929	AZ
3	207P00000X	Emergency Medicine Physician	01097875A	IN
4	207P00000X	Emergency Medicine Physician	A70318	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	:	1730197062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAWCHYI LEE MD

Provider Business Mailing Address
First Line	:	16835 ALGONQUIN ST # 125
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92649-3810
Country	:	US
Telephone Number	:	310-529-7734
Fax Number	:

Provider Business Practice Location Address
First Line	:	13428 MAXELLA AVENUE #759
Second Line	:
City	:	MARINA DEL REY
State	:	CA
Zip	:	90292-6090
Country	:	US
Telephone Number	:	310-529-7734
Fax Number	:

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

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	05/28/2026

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