Individual
JASON MICHAEL LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1207 FAIRCHILD CT, WOODLAND, CA 95695-4321
(530) 668-2600
(530) 669-5695
Mailing address
3400 DATA DR, ATTN CREDENTIALING/PAYER ENROLLMENT, RANCHO CORDOVA, CA 95670-7956
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
20A18303
CA
2084P0804X
Child & Adolescent Psychiatry Physician
34.012844
OH
Other
Enumeration date
05/01/2015
Last updated
07/31/2020
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