MEDICARE: HEE TAE LEE

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95037221	CA
2	163W00000X	Registered Nurse	95231436	CA

General Provider Information

NPI Number	:	1174415749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEE TAE LEE

Provider Business Mailing Address
First Line	:	2466 MONTROSE AVE APT 2
Second Line	:
City	:	MONTROSE
State	:	CA
Zip	:	91020-1476
Country	:	US
Telephone Number	:	213-703-5526
Fax Number	:

Provider Business Practice Location Address
First Line	:	3030 W OLYMPIC BLVD STE 217
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-6507
Country	:	US
Telephone Number	:	213-703-5526
Fax Number	:

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

Provider Enumeration Date	:	07/17/2025
Last Update Date	:	12/01/2025

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Directions to “ HEE TAE LEE ” Practice Location

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