Provider Demographics
NPI:1306567482
Name:LEE, HYUN JIN
Entity type:Individual
Prefix:
First Name:HYUN
Middle Name:JIN
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10015 CAMPESTRAL CT
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-6614
Mailing Address - Country:US
Mailing Address - Phone:770-789-6957
Mailing Address - Fax:678-426-6100
Practice Address - Street 1:10015 CAMPESTRAL CT
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-6614
Practice Address - Country:US
Practice Address - Phone:770-789-6957
Practice Address - Fax:678-426-6100
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHCP011074374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide