MEDICARE: MS. KIA LEE MSN, ANP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	16642	CA

General Provider Information

NPI Number	:	1003956012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIA LEE MSN, ANP-BC

Provider Business Mailing Address
First Line	:	PO BOX 4013
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91909-4013
Country	:	US
Telephone Number	:	704-281-4088
Fax Number	:

Provider Business Practice Location Address
First Line	:	5565 GROSSMONT CENTER DR STE 1
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91942-3000
Country	:	US
Telephone Number	:	619-567-1550
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	11/02/2025

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