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General NPI Number Information
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NPI Number | 1962046714
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Entity Type | Individual
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Provider Name | ELLEN KYUNGCHAE LEE PA
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Gender | Female
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Dates
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Enumeration Date | 11/05/2019
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 2221 LINCOLN BLVD STE 100
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City | SANTA MONICA
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State | CA
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Zip | 90405-1320
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Country | US
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Telephone | 310-392-1111
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Fax | 310-392-1101
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Provider Business Mailing Address
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Address Line | 2221 LINCOLN BLVD STE 100
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City | SANTA MONICA
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State | CA
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Zip | 90405-1320
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Country | US
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Telephone | 310-392-1111
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Fax | 310-392-1101
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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