Provider Demographics
NPI:1881213874
Name:AN, SARAH LEE (NP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LEE
Last Name:AN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25427 PINE CREEK LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:90744-1859
Mailing Address - Country:US
Mailing Address - Phone:818-515-5491
Mailing Address - Fax:
Practice Address - Street 1:3640 LOMITA BLVD STE 106
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3920
Practice Address - Country:US
Practice Address - Phone:310-784-8713
Practice Address - Fax:310-891-6749
Is Sole Proprietor?:No
Enumeration Date:2020-04-10
Last Update Date:2020-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013856363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner