Provider Demographics
NPI:1093265340
Name:LEE, EUNJUNG (NP-C)
Entity Type:Individual
Prefix:
First Name:EUNJUNG
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32424 CROWN VALLEY PKWY APT 103
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3329
Mailing Address - Country:US
Mailing Address - Phone:201-266-0172
Mailing Address - Fax:
Practice Address - Street 1:32424 CROWN VALLEY PKWY
Practice Address - Street 2:APT 103
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-3329
Practice Address - Country:US
Practice Address - Phone:201-381-9483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002851363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily