Healthcare Provider Details

I. General information

NPI: 1801604459
Provider Name (Legal Business Name): DCL ANESTHESIA NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2024
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 E AVENIDA DE LOS ARBOLES STE 101
THOUSAND OAKS CA
91360-3017
US

IV. Provider business mailing address

PO BOX 7001
TARZANA CA
91357-7001
US

V. Phone/Fax

Practice location:
  • Phone: 805-241-0151
  • Fax:
Mailing address:
  • Phone: 818-888-7815
  • Fax: 818-715-1722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: DAVID CHONG HYUN LEE
Title or Position: PRESIDENT
Credential: CRNA
Phone: 808-224-0083