Provider Demographics
NPI:1134198922
Name:LEE, JUDY JOOYUN (MD)
Entity type:Individual
Prefix:DR
First Name:JUDY
Middle Name:JOOYUN
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N. VERMONT AVE
Mailing Address - Street 2:SUITE 1002
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-1830
Mailing Address - Country:US
Mailing Address - Phone:323-953-7170
Mailing Address - Fax:
Practice Address - Street 1:4618 FOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1977
Practice Address - Country:US
Practice Address - Phone:323-953-7170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75018208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics