Provider Demographics
NPI:1497318109
Name:LEE, JI YOUNG (MSN, NP-C)
Entity Type:Individual
Prefix:
First Name:JI
Middle Name:YOUNG
Last Name:LEE
Suffix:
Gender:F
Credentials:MSN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6261 STANTON AVE
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-2436
Mailing Address - Country:US
Mailing Address - Phone:714-739-4325
Mailing Address - Fax:714-739-4076
Practice Address - Street 1:6261 STANTON AVE
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-2436
Practice Address - Country:US
Practice Address - Phone:714-739-4325
Practice Address - Fax:714-739-4076
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-18
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011530363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily