Healthcare Provider Details

I. General information

NPI: 1972384840
Provider Name (Legal Business Name): PAUL LEE MSN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 WILSHIRE BLVD STE 406
LOS ANGELES CA
90017-4804
US

IV. Provider business mailing address

PO BOX 51954
IRVINE CA
92619-1954
US

V. Phone/Fax

Practice location:
  • Phone: 213-372-5245
  • Fax: 213-372-5217
Mailing address:
  • Phone: 646-584-0770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95026899
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95192178
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: