Organization
JAESUNG LEE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAESUNG LEE M.D. (OWNER)
(805) 379-9646
Entity
Organization
Contact information
Practice address
301 S MOORPARK RD, THOUSAND OAKS, CA 91361-1008
(805) 379-9646
(805) 379-0611
Mailing address
301 S MOORPARK RD, THOUSAND OAKS, CA 91361-1008
(805) 379-9646
(805) 379-0611
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G64716
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G64716
LICENSE
CA
Enumeration date
06/26/2007
Last updated
08/27/2010
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