Provider Demographics
NPI:1447288204
Name:LEE, JENNIFER TUNG (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:TUNG
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:15620 HEALDSBURG AVENUE
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448
Mailing Address - Country:US
Mailing Address - Phone:707-473-4531
Mailing Address - Fax:707-473-4559
Practice Address - Street 1:3536 MENDOCINO AVENUE
Practice Address - Street 2:SUITE 300
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403
Practice Address - Country:US
Practice Address - Phone:707-571-1280
Practice Address - Fax:707-578-5849
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA89100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine