Provider Demographics
NPI:1639804818
Name:LOR, HLEE (PA)
Entity Type:Individual
Prefix:
First Name:HLEE
Middle Name:
Last Name:LOR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7701 COLLEGE TOWN DR APT 12
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-2309
Mailing Address - Country:US
Mailing Address - Phone:916-468-2977
Mailing Address - Fax:
Practice Address - Street 1:87 SCRIPPS DR STE 116
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6379
Practice Address - Country:US
Practice Address - Phone:925-685-4224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-20
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61988363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty