Provider Demographics
NPI:1447743687
Name:LEE, JI EUN (LVN)
Entity Type:Individual
Prefix:
First Name:JI
Middle Name:EUN
Last Name:LEE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2026 W BEACON AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-4406
Mailing Address - Country:US
Mailing Address - Phone:657-276-7030
Mailing Address - Fax:714-426-8160
Practice Address - Street 1:2026 W BEACON AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-4406
Practice Address - Country:US
Practice Address - Phone:657-276-7030
Practice Address - Fax:714-426-8160
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA269491164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse