Provider Demographics
NPI:1861405722
Name:LEE, EUNICE U (MD)
Entity type:Individual
Prefix:
First Name:EUNICE
Middle Name:U
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:PO BOX 12305
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92658-5058
Mailing Address - Country:US
Mailing Address - Phone:949-502-7110
Mailing Address - Fax:
Practice Address - Street 1:3500 BARRANCA PKWY
Practice Address - Street 2:STE 330
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-8288
Practice Address - Country:US
Practice Address - Phone:949-502-7110
Practice Address - Fax:844-809-2241
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65466207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH69920Medicare UPIN