Healthcare Provider Details

I. General information

NPI: 1750785531
Provider Name (Legal Business Name): EUNA LEE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2014
Last Update Date: 11/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S DOUGLAS HOSPITAL, 3200
ORANGE CA
92868-3201
US

IV. Provider business mailing address

11432 SOUTH ST # 153
CERRITOS CA
90703-6611
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-7012
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95001098
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF338254
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number565595
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95030088
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: