Provider Demographics
NPI:1417304452
Name:LEE, HANNA
Entity type:Individual
Prefix:MS
First Name:HANNA
Middle Name:
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 1:10201 RESEDA BLVD
Mailing Address - Street 2:#112
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-5010
Mailing Address - Country:US
Mailing Address - Phone:818-772-8008
Mailing Address - Fax:818-772-5575
Practice Address - Street 1:10201 RESEDA BLVD
Practice Address - Street 2:#112
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-5010
Practice Address - Country:US
Practice Address - Phone:818-772-8008
Practice Address - Fax:818-772-5575
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD7559156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician