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NPI Code Detail

MEDICARE: JI YOUNG LEE MSN, NP-C

MEDICARE: JI YOUNG LEE MSN, NP-C
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
1363LF0000XFamily Nurse Practitioner95011530CA

General Provider Information

NPI Number : 1497318109
Entity Type Code : Individual
Provider Name (Legal Business Name) : JI YOUNG LEE MSN, NP-C
Provider Business Mailing Address
First Line : 6261 STANTON AVE
Second Line :
City : BUENA PARK
State : CA
Zip : 90621-2436
Country : US
Telephone Number : 714-739-4325
Fax Number : 714-739-4076
Provider Business Practice Location Address
First Line : 6261 STANTON AVE
Second Line :
City : BUENA PARK
State : CA
Zip : 90621-2436
Country : US
Telephone Number : 714-739-4325
Fax Number : 714-739-4076
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2019
Last Update Date : 12/29/2022

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