Provider Demographics
NPI:1053708305
Name:LEE, JENNIFER (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8701 CUYAMACA ST
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-4253
Mailing Address - Country:US
Mailing Address - Phone:619-568-8220
Mailing Address - Fax:619-568-8089
Practice Address - Street 1:8701 CUYAMACA ST
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-4253
Practice Address - Country:US
Practice Address - Phone:619-568-8220
Practice Address - Fax:619-568-8089
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA168637207WX0108X, 207W00000X
IL036.148397207WX0108X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0108XAllopathic & Osteopathic PhysiciansOphthalmologyUveitis and Ocular Inflammatory Disease
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology