Provider Demographics
NPI:1003956012
Name:LEE, KIA (NP, MSN, BA)
Entity Type:Individual
Prefix:MS
First Name:KIA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:NP, MSN, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4331 53RD ST APT 16
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-5268
Mailing Address - Country:US
Mailing Address - Phone:619-818-7205
Mailing Address - Fax:
Practice Address - Street 1:655 EUCLID AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2957
Practice Address - Country:US
Practice Address - Phone:619-818-7205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16642363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health