Provider Demographics
NPI:1144974692
Name:LEE, MIN JUNG
Entity type:Individual
Prefix:DR
First Name:MIN
Middle Name:JUNG
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 NILES ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93305-4731
Mailing Address - Country:US
Mailing Address - Phone:661-327-9317
Mailing Address - Fax:661-327-8214
Practice Address - Street 1:1405 NILES ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93305-4731
Practice Address - Country:US
Practice Address - Phone:661-327-9317
Practice Address - Fax:661-327-8214
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43384183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist