Individual
MR. JIMMY SEUNG-SUP LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1290 TAVERN RD, MAMMOTH LAKES, CA 93546-6601
(760) 924-1740
Mailing address
PO BOX 100 PMB 352, MAMMOTH LAKES, CA 93546
(310) 422-8005
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
790804
CA
Other
Enumeration date
12/28/2021
Last updated
12/28/2021
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