Healthcare Provider Details

I. General information

NPI: 1932059250
Provider Name (Legal Business Name): EUNJIN LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 BROCKTON AVE STE 200
RIVERSIDE CA
92506-3818
US

IV. Provider business mailing address

6900 BROCKTON AVE STE 200
RIVERSIDE CA
92506-3818
US

V. Phone/Fax

Practice location:
  • Phone: 951-682-6263
  • Fax:
Mailing address:
  • Phone: 951-682-6263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95031440
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: