Provider Demographics
NPI:1558627901
Name:LEE, JENNIE ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:ELIZABETH
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIE
Other - Middle Name:
Other - Last Name:NGHIEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:395 HICKEY BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2770
Mailing Address - Country:US
Mailing Address - Phone:650-301-4580
Mailing Address - Fax:
Practice Address - Street 1:395 HICKEY BLVD FL 2
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2770
Practice Address - Country:US
Practice Address - Phone:650-301-4580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA128520208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics