Healthcare Provider Details

I. General information

NPI: 1558602581
Provider Name (Legal Business Name): HEEJIN LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2013
Last Update Date: 03/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9482 CALIFORNIA CITY BLVD
CALIFORNIA CITY CA
93505
US

IV. Provider business mailing address

38451 5TH ST W APT A7
PALMDALE CA
93551
US

V. Phone/Fax

Practice location:
  • Phone: 760-373-5268
  • Fax:
Mailing address:
  • Phone: 319-321-7862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number68660
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: