Basic Information
| Provider Information | |||||||||
| NPI: | 1992076905 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | SEUNG EUN | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 795 WILLOW RD | ||||||||
| Address2: | BLDG 332 | ||||||||
| City: | MENLO PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940252539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503241470 | ||||||||
| FaxNumber: | 6503244149 | ||||||||
| Practice Location | |||||||||
| Address1: | 795 WILLOW RD | ||||||||
| Address2: | BLDG 332 | ||||||||
| City: | MENLO PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940252539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503241470 | ||||||||
| FaxNumber: | 6503244149 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2012 | ||||||||
| LastUpdateDate: | 01/23/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 553556 | CA | N | Nursing Service Providers | Registered Nurse | 363LA2200X | 20446 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.