Healthcare Provider Details

I. General information

NPI: 1881505394
Provider Name (Legal Business Name): HYEONG GYEONG LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 KINDERKAMACK RD UNIT 415
HACKENSACK NJ
07601-4869
US

IV. Provider business mailing address

2 KINDERKAMACK RD UNIT 415
HACKENSACK NJ
07601-4869
US

V. Phone/Fax

Practice location:
  • Phone: 503-729-0085
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR28109300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: