Provider Demographics
NPI:1700225422
Name:LEE, JULIA SHIN (MD)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:SHIN
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:SOOJUNG
Other - Last Name:SHIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20911 EARL ST STE 301
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4354
Mailing Address - Country:US
Mailing Address - Phone:310-371-1388
Mailing Address - Fax:310-371-3439
Practice Address - Street 1:20911 EARL ST STE 301
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4354
Practice Address - Country:US
Practice Address - Phone:310-371-1388
Practice Address - Fax:310-371-3439
Is Sole Proprietor?:No
Enumeration Date:2013-06-15
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA133831207K00000X
CAE1254762207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology