Healthcare Provider Details

I. General information

NPI: 1629483102
Provider Name (Legal Business Name): HYUNJU LEE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7851 WALKER ST STE 103
LA PALMA CA
90623-1734
US

IV. Provider business mailing address

12372 GARDEN GROVE BLVD STE B
GARDEN GROVE CA
92843-1805
US

V. Phone/Fax

Practice location:
  • Phone: 714-422-0440
  • Fax: 714-494-4210
Mailing address:
  • Phone: 714-583-8569
  • Fax: 714-661-5371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number260347
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberA146630
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: