Provider Demographics
NPI:1043861248
Name:LEE, CHENG-HSIEN JIM (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHENG-HSIEN
Middle Name:JIM
Last Name:LEE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17557 MONTERO RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2345
Mailing Address - Country:US
Mailing Address - Phone:858-605-8838
Mailing Address - Fax:
Practice Address - Street 1:635 S MELROSE DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6622
Practice Address - Country:US
Practice Address - Phone:760-643-3904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-28
Last Update Date:2019-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76549183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist