Provider Demographics
NPI:1194977389
Name:LEE, EUNICE YOUNG (RN, GNP)
Entity type:Individual
Prefix:
First Name:EUNICE
Middle Name:YOUNG
Last Name:LEE
Suffix:
Gender:F
Credentials:RN, GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16111 PLUMMER ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-2036
Mailing Address - Country:US
Mailing Address - Phone:818-891-7711
Mailing Address - Fax:
Practice Address - Street 1:5901 W. OLYMPIC BLVD.
Practice Address - Street 2:#301
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4664
Practice Address - Country:US
Practice Address - Phone:323-931-3100
Practice Address - Fax:323-931-0030
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP13665363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW11213Medicare PIN