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NPI Code Detail

MEDICARE: KEVIN HOSEOK LEE NP

MEDICARE:   KEVIN HOSEOK LEE  NP
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner95034991CA

General Provider Information

NPI Number : 1063255560
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEVIN HOSEOK LEE NP
Provider Business Mailing Address
First Line : 1906 S PALM GROVE AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90016-1630
Country : US
Telephone Number : 571-451-7470
Fax Number :
Provider Business Practice Location Address
First Line : 1906 S PALM GROVE AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90016-1630
Country : US
Telephone Number : 571-451-7470
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2024
Last Update Date : 01/30/2026

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