Provider Demographics
NPI:1174571491
Name:LEE, JENNIFER KIM
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KIM
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:KIM
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7 IROQUOIS CT
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-0752
Mailing Address - Country:US
Mailing Address - Phone:310-903-6615
Mailing Address - Fax:
Practice Address - Street 1:3430 E LA PALMA AVE
Practice Address - Street 2:MOB 2 OBGYN
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-2020
Practice Address - Country:US
Practice Address - Phone:714-644-2560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81453174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABR8230699OtherDEA NUMBER