Healthcare Provider Details

I. General information

NPI: 1215856356
Provider Name (Legal Business Name): JENNY LEE DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8022 MELROSE AVENUE
LOS ANGELES CA
90046
US

IV. Provider business mailing address

625 S BERENDO ST APT 513
LOS ANGELES CA
90005-1753
US

V. Phone/Fax

Practice location:
  • Phone: 443-614-1886
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95327713
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: