Healthcare Provider Details

I. General information

NPI: 1588392146
Provider Name (Legal Business Name): HANJUN LEE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 W OLYMPIC BLVD
LOS ANGELES CA
90006-2800
US

IV. Provider business mailing address

2455 ONEIDA ST UNIT B
PASADENA CA
91107-5258
US

V. Phone/Fax

Practice location:
  • Phone: 213-480-1503
  • Fax:
Mailing address:
  • Phone: 760-705-7953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number85597
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: