Provider Demographics
NPI:1972384840
Name:LEE, PAUL (MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51954
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92619-1954
Mailing Address - Country:US
Mailing Address - Phone:646-584-0770
Mailing Address - Fax:
Practice Address - Street 1:1245 WILSHIRE BLVD STE 406
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4804
Practice Address - Country:US
Practice Address - Phone:213-372-5245
Practice Address - Fax:213-372-5217
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95192178163W00000X
CA95026899363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse