Healthcare Provider Details

I. General information

NPI: 1578416699
Provider Name (Legal Business Name): SUN GYU LEE MSN, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2026
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14228 SARANAC LN
SYLMAR CA
91342-1435
US

IV. Provider business mailing address

14228 SARANAC LN
SYLMAR CA
91342-1435
US

V. Phone/Fax

Practice location:
  • Phone: 747-315-6100
  • Fax:
Mailing address:
  • Phone: 747-315-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95038795
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: