Provider Demographics
NPI:1144885252
Name:LEE, YU-YEN (RD, RDN)
Entity type:Individual
Prefix:
First Name:YU-YEN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:RD, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13630 SAN ANTONIO AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-7321
Mailing Address - Country:US
Mailing Address - Phone:909-306-9895
Mailing Address - Fax:
Practice Address - Street 1:665 N D ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92401-1109
Practice Address - Country:US
Practice Address - Phone:909-708-8158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-03
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86103443133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered