Healthcare Provider Details

I. General information

NPI: 1265643506
Provider Name (Legal Business Name): SUN MIN LEE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 W OLYMPIC BLVD STE 104
LOS ANGELES CA
90006-2800
US

IV. Provider business mailing address

716 VALLEY VIEW RD
SOUTH PASADENA CA
91030-4211
US

V. Phone/Fax

Practice location:
  • Phone: 213-480-1503
  • Fax:
Mailing address:
  • Phone: 323-256-1591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number43932
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: