Provider Demographics
NPI:1366945016
Name:LEE, HANNAH HYEKYUNG (FNP)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:HYEKYUNG
Last Name:LEE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8021 DORADO CIR
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-1969
Mailing Address - Country:US
Mailing Address - Phone:301-706-8733
Mailing Address - Fax:
Practice Address - Street 1:20145 PIONEER BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90715-1051
Practice Address - Country:US
Practice Address - Phone:562-916-5020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-08
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR185262363LF0000X
CA95008288363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily