Healthcare Provider Details

I. General information

NPI: 1639478803
Provider Name (Legal Business Name): CHRISTINA HYELIM LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2011
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD MS#3
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

6913 CREST RD
RANCHO PALOS VERDES CA
90275-4540
US

V. Phone/Fax

Practice location:
  • Phone: 310-766-8539
  • Fax:
Mailing address:
  • Phone: 310-766-8539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA134202
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberA134202
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: