Provider Demographics
NPI:1649069303
Name:LEE, ELINA JIYEUN
Entity type:Individual
Prefix:MISS
First Name:ELINA
Middle Name:JIYEUN
Last Name:LEE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8209 CABERNET LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-1140
Mailing Address - Country:US
Mailing Address - Phone:832-758-3424
Mailing Address - Fax:
Practice Address - Street 1:8209 CABERNET LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-1140
Practice Address - Country:US
Practice Address - Phone:832-758-3424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program