Healthcare Provider Details

I. General information

NPI: 1366959199
Provider Name (Legal Business Name): HYEIN KATHY LEE CPNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHY LEE CPNP-AC

II. Dates (important events)

Enumeration Date: 01/02/2018
Last Update Date: 01/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 BROADWAY 11C PICU
NEW YORK NY
10032
US

IV. Provider business mailing address

6 STUYVESANT OVAL APT 9B
NEW YORK NY
10009-2418
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-3281
  • Fax:
Mailing address:
  • Phone: 310-502-1560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License NumberF431205-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: