Provider Demographics
NPI:1023264314
Name:LEE, CAROLINA KEYJUNG (OD)
Entity type:Individual
Prefix:DR
First Name:CAROLINA
Middle Name:KEYJUNG
Last Name:LEE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 MEANDER
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-7341
Mailing Address - Country:US
Mailing Address - Phone:425-698-9130
Mailing Address - Fax:
Practice Address - Street 1:27785 SANTA MARGARITA PKWY STE 200
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6652
Practice Address - Country:US
Practice Address - Phone:949-670-0199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3545152W00000X
CA35394152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist