Provider Demographics
NPI:1174648687
Name:LEE, JAEHOON (OD)
Entity Type:Individual
Prefix:DR
First Name:JAEHOON
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:19179 BEAR VALLEY RD
Mailing Address - Street 2:#10
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92308-2724
Mailing Address - Country:US
Mailing Address - Phone:760-240-9679
Mailing Address - Fax:760-247-0076
Practice Address - Street 1:19179 BEAR VALLEY RD
Practice Address - Street 2:#10
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92308-2724
Practice Address - Country:US
Practice Address - Phone:760-240-9679
Practice Address - Fax:760-247-0076
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12239T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist