Provider Demographics
NPI:1306045802
Name:LEE, JIMMY KYUNG (MD)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:KYUNG
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4300 LONG BEACH BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2008
Mailing Address - Country:US
Mailing Address - Phone:562-591-7700
Mailing Address - Fax:562-591-1311
Practice Address - Street 1:4300 LONG BEACH BLVD STE 400
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2008
Practice Address - Country:US
Practice Address - Phone:562-591-7700
Practice Address - Fax:562-591-7700
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY268042207WX0120X
CT046742207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Yes207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist