Provider Demographics
NPI:1437319761
Name:LEE, JIN PYO (MD)
Entity Type:Individual
Prefix:DR
First Name:JIN
Middle Name:PYO
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 PREMIERE HILLS CIR
Mailing Address - Street 2:#222
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-0896
Mailing Address - Country:US
Mailing Address - Phone:818-992-6251
Mailing Address - Fax:
Practice Address - Street 1:4950 W SUNSET BLVD
Practice Address - Street 2:4TH FLOOR, FAMILY PRACTICE
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5822
Practice Address - Country:US
Practice Address - Phone:323-783-7898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104296207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine