Provider Demographics
NPI:1669726238
Name:LEE, JACKY LUNG HING (PHARMD, MBA)
Entity type:Individual
Prefix:DR
First Name:JACKY
Middle Name:LUNG HING
Last Name:LEE
Suffix:
Gender:M
Credentials:PHARMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11790 PAPAGALLO CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-2802
Mailing Address - Country:US
Mailing Address - Phone:858-229-9282
Mailing Address - Fax:
Practice Address - Street 1:9323 CHESAPEAKE DR STE C1
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1034
Practice Address - Country:US
Practice Address - Phone:858-229-9282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59318183500000X
NY054727183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist