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General NPI Number Information
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NPI Number | 1447637392
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Entity Type | Individual
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Provider Name | DAVID CHONG HYUN LEE CRNA
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Gender | Male
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Dates
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Enumeration Date | 04/29/2015
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Last Update Date | 11/01/2022
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Provider Practice Location Address
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Address Line | 18880 BRASILIA DR
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City | PORTER RANCH
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State | CA
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Zip | 91326-1950
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Country | US
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Telephone | 808-224-0083
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Fax |
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Provider Business Mailing Address
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Address Line | 538 S OAKLAND AVE APT 304
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City | PASADENA
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State | CA
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Zip | 91101-4017
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Country | US
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Telephone | 808-224-0083
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 839542
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 61834
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License Number State | HI
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 95000324
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License Number State | CA
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