Provider Demographics
NPI:1134891146
Name:LEE, JAMIE JINJU (AUD)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:JINJU
Last Name:LEE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BRANDY LN
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-2933
Mailing Address - Country:US
Mailing Address - Phone:909-241-5589
Mailing Address - Fax:
Practice Address - Street 1:24352 ROCKFIELD BLVD
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-4742
Practice Address - Country:US
Practice Address - Phone:949-461-0166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3653231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist