Healthcare Provider Details

I. General information

NPI: 1649197096
Provider Name (Legal Business Name): NAYOUNG LEE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

10650 MOUNTAIN VIEW AVE APT 201
REDLANDS CA
92373-8434
US

IV. Provider business mailing address

10650 MOUNTAIN VIEW AVE APT 201
REDLANDS CA
92373-8434
US

V. Phone/Fax

Practice location:
  • Phone: 909-258-9895
  • Fax:
Mailing address:
  • Phone: 909-258-9895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN95339689
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: