Provider Demographics
NPI:1629274238
Name:LEE, JENNY INCHIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:INCHIN
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1313 LAUREL ST STE 106
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-5013
Mailing Address - Country:US
Mailing Address - Phone:650-591-2678
Mailing Address - Fax:650-591-7452
Practice Address - Street 1:1313 LAUREL ST STE 106
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-5013
Practice Address - Country:US
Practice Address - Phone:650-591-2678
Practice Address - Fax:650-591-7452
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.118756207RN0300X
CAA110984207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology