Provider Demographics
NPI:1962046714
Name:LEE, ELLEN KYUNGCHAE (PA)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:KYUNGCHAE
Last Name:LEE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2221 LINCOLN BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-1320
Mailing Address - Country:US
Mailing Address - Phone:310-392-1111
Mailing Address - Fax:310-392-1101
Practice Address - Street 1:2221 LINCOLN BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-1320
Practice Address - Country:US
Practice Address - Phone:310-392-1111
Practice Address - Fax:310-392-1101
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2024-08-26
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant