Healthcare Provider Details

I. General information

NPI: 1558283192
Provider Name (Legal Business Name): HYUNJUNG LEE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

358 W VALLEY BLVD UNIT 201
SAN GABRIEL CA
91776-5724
US

IV. Provider business mailing address

3545 WILSHIRE BLVD APT 1231
LOS ANGELES CA
90010-4315
US

V. Phone/Fax

Practice location:
  • Phone: 626-288-8878
  • Fax:
Mailing address:
  • Phone: 917-318-5234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95040735
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: