Provider Demographics
NPI:1558672550
Name:LEE, EUNJOO (FNP & LAC)
Entity Type:Individual
Prefix:MRS
First Name:EUNJOO
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:FNP & LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25039 HIDDEN WILLOW CIR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91387-1463
Mailing Address - Country:US
Mailing Address - Phone:213-268-7202
Mailing Address - Fax:213-280-0029
Practice Address - Street 1:8100 SUNLAND BLVD
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-3948
Practice Address - Country:US
Practice Address - Phone:818-306-4896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2023-03-01
Deactivation Date:2023-02-06
Deactivation Code:
Reactivation Date:2023-02-15
Provider Licenses
StateLicense IDTaxonomies
CAAC13298171100000X
CANP95024260363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No171100000XOther Service ProvidersAcupuncturist