Healthcare Provider Details

I. General information

NPI: 1235010240
Provider Name (Legal Business Name): JUNG HYUN LEE
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: JUNG HYUN IRENE LEE

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14330 CULVER DR
IRVINE CA
92604-0303
US

IV. Provider business mailing address

3385 MICHELSON DR APT 213
IRVINE CA
92612-3459
US

V. Phone/Fax

Practice location:
  • Phone: 909-999-1432
  • Fax:
Mailing address:
  • Phone: 909-999-1432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95038188
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: