Provider Demographics
NPI:1578238507
Name:LEE, SUSAN JINHEE (PA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:JINHEE
Last Name:LEE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33075 TIVOLI ST
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-4369
Mailing Address - Country:US
Mailing Address - Phone:702-281-9865
Mailing Address - Fax:
Practice Address - Street 1:41011 CALIFORNIA OAKS RD STE 103
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5751
Practice Address - Country:US
Practice Address - Phone:951-676-4193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA60608363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant