Provider Demographics
NPI:1003956012
Name:LEE, KIA (MSN, ANP-BC)
Entity type:Individual
Prefix:MS
First Name:KIA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MSN, ANP-BC
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 4013
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91909-4013
Mailing Address - Country:US
Mailing Address - Phone:704-281-4088
Mailing Address - Fax:
Practice Address - Street 1:5565 GROSSMONT CENTER DR STE 1
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3000
Practice Address - Country:US
Practice Address - Phone:619-567-1550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2025-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16642363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health