Provider Demographics
NPI:1447292545
Name:LEE, SINJIN (MD)
Entity type:Individual
Prefix:DR
First Name:SINJIN
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 1/2 CARNATION AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-2852
Mailing Address - Country:US
Mailing Address - Phone:949-648-2108
Mailing Address - Fax:
Practice Address - Street 1:3080 BRISTOL ST
Practice Address - Street 2:SUITE #600
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-3093
Practice Address - Country:US
Practice Address - Phone:949-837-1578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226299207RC0000X
CAA108586207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty