MEDICARE: EUN MI 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	163WH0500X	Hemodialysis Registered Nurse	RN95300073	CA

General Provider Information

NPI Number	:	1366261521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUN MI LEE

Provider Business Mailing Address
First Line	:	1365 CATHEDRAL OAKS RD
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91913-2523
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	858 FLETCHER PKWY
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92020-1818
Country	:	US
Telephone Number	:	619-442-4122
Fax Number	:

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

Provider Enumeration Date	:	10/05/2024
Last Update Date	:	10/05/2024

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Directions to “ EUN MI LEE ” Practice Location

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