Provider Demographics
NPI:1134180946
Name:LEE, JEONG OK (MD)
Entity type:Individual
Prefix:DR
First Name:JEONG
Middle Name:OK
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1801 W ROMNEYA DR
Mailing Address - Street 2:SUITE #606
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1830
Mailing Address - Country:US
Mailing Address - Phone:714-635-0600
Mailing Address - Fax:714-635-0610
Practice Address - Street 1:1801 W ROMNEYA DR
Practice Address - Street 2:SUITE #606
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1830
Practice Address - Country:US
Practice Address - Phone:714-635-0600
Practice Address - Fax:714-635-0610
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA39186208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A391861Medicaid
CA00A391861Medicaid