Healthcare Provider Details

I. General information

NPI: 1427596592
Provider Name (Legal Business Name): HAEJIN JOYCE LEE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2017
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 S BRISTOL ST STE 110
SANTA ANA CA
92704-6210
US

IV. Provider business mailing address

1920 S WATSON ST
LA HABRA CA
90631-9512
US

V. Phone/Fax

Practice location:
  • Phone: 888-499-9303
  • Fax:
Mailing address:
  • Phone: 213-270-3191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95005981
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: