Healthcare Provider Details

I. General information

NPI: 1558672550
Provider Name (Legal Business Name): EUNJOO LEE FNP & L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date: 02/06/2023
Reactivation Date: 02/15/2023

III. Provider practice location address

8100 SUNLAND BLVD
SUN VALLEY CA
91352-3948
US

IV. Provider business mailing address

25039 HIDDEN WILLOW CIR
SANTA CLARITA CA
91387-1463
US

V. Phone/Fax

Practice location:
  • Phone: 818-306-4896
  • Fax:
Mailing address:
  • Phone: 213-268-7202
  • Fax: 213-280-0029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC13298
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95024260
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: