MEDICARE: YEONG LEE NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	95015600	CA

General Provider Information

NPI Number	:	1699359133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YEONG LEE NP

Provider Business Mailing Address
First Line	:	629 TRACTION AVE APT 257
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90013-1690
Country	:	US
Telephone Number	:	310-634-6030
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 S VIRGIL AVE STE 501
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-1442
Country	:	US
Telephone Number	:	213-381-0700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2021
Last Update Date	:	05/11/2021

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