Healthcare Provider Details

I. General information

NPI: 1295142149
Provider Name (Legal Business Name): KYUNG WOON LEE FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2014
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 PLACER ST
REDDING CA
96001-1170
US

IV. Provider business mailing address

1035 PLACER ST
REDDING CA
96001-1170
US

V. Phone/Fax

Practice location:
  • Phone: 530-246-5883
  • Fax: 530-244-7846
Mailing address:
  • Phone: 530-246-5883
  • Fax: 530-244-7846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95006454
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP95006454
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: