Provider Demographics
NPI:1578948089
Name:LEE, KIMBERLY DONGHEE (NP-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DONGHEE
Last Name:LEE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:DONGHEE
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8860 CENTER DR STE 400
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-7003
Mailing Address - Country:US
Mailing Address - Phone:619-229-1995
Mailing Address - Fax:619-229-1109
Practice Address - Street 1:8860 CENTER DR STE 400
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-7003
Practice Address - Country:US
Practice Address - Phone:619-229-1995
Practice Address - Fax:619-229-1109
Is Sole Proprietor?:No
Enumeration Date:2015-07-26
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002694363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA724057OtherCA LICENSE