Healthcare Provider Details

I. General information

NPI: 1700730413
Provider Name (Legal Business Name): JONG SUN LEE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2026
Last Update Date: 02/21/2026
Certification Date: 02/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 WILSHIRE PL STE 309
LOS ANGELES CA
90005-3930
US

IV. Provider business mailing address

360 S KENMORE AVE APT 204
LOS ANGELES CA
90020-2328
US

V. Phone/Fax

Practice location:
  • Phone: 213-618-5686
  • Fax:
Mailing address:
  • Phone: 213-618-5686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95038660
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: