Provider Demographics
NPI:1699243618
Name:LEE, DAVID KANG (RN)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:KANG
Last Name:LEE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1376 CARISSA ST
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91784-7362
Mailing Address - Country:US
Mailing Address - Phone:909-677-7479
Mailing Address - Fax:
Practice Address - Street 1:765 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-1181
Practice Address - Country:US
Practice Address - Phone:213-580-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95047223163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse