Healthcare Provider Details

I. General information

NPI: 1013622299
Provider Name (Legal Business Name): HELENA KEESOON LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 01/23/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 ALAMEDA DE LAS PULGAS
REDWOOD CITY CA
94062-2751
US

IV. Provider business mailing address

88 HILLVIEW AVE
REDWOOD CITY CA
94062-2118
US

V. Phone/Fax

Practice location:
  • Phone: 650-369-5811
  • Fax:
Mailing address:
  • Phone: 650-454-9440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95023876
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: