Provider Demographics
NPI:1053986117
Name:LEE, MICHELLE YOON-JI (PA-C)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:YOON-JI
Last Name:LEE
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17051 SIERRA LAKES PKWY STE 101
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-1274
Practice Address - Country:US
Practice Address - Phone:909-864-4700
Practice Address - Fax:909-428-2191
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2024-04-29
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant