Provider Demographics
NPI:1639349111
Name:LEE, JIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JIN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MYUNG-JIN
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10243 GENETIC CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-6310
Mailing Address - Country:US
Mailing Address - Phone:858-526-6175
Mailing Address - Fax:858-526-6017
Practice Address - Street 1:10243 GENETIC CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-6310
Practice Address - Country:US
Practice Address - Phone:858-526-6175
Practice Address - Fax:858-526-6017
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA224917207N00000X
NY247406-1207N00000X
CO50381207N00000X
CAA109932207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO022236OtherKAISER COMMERCIAL NUMBER
CO53970845Medicaid
CO022236OtherKAISER COMMERCIAL NUMBER