Healthcare Provider Details

I. General information

NPI: 1114763448
Provider Name (Legal Business Name): HAEEUN LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2024
Last Update Date: 07/05/2024
Certification Date: 07/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 LINDELL RD
LAS VEGAS NV
89146-6815
US

IV. Provider business mailing address

2120 RAMROD AVE UNIT 1812
HENDERSON NV
89014-2019
US

V. Phone/Fax

Practice location:
  • Phone: 702-253-2806
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: