Healthcare Provider Details

I. General information

NPI: 1366945016
Provider Name (Legal Business Name): HANNAH HYEKYUNG LEE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2018
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 CAMFIELD AVE
LOS ANGELES CA
90040-1501
US

IV. Provider business mailing address

104 SCALE
IRVINE CA
92618-1371
US

V. Phone/Fax

Practice location:
  • Phone: 323-622-2429
  • Fax:
Mailing address:
  • Phone: 301-706-8733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95008288
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: