Provider Demographics
NPI:1295142149
Name:LEE, KYUNG WOON (FNP)
Entity type:Individual
Prefix:MR
First Name:KYUNG WOON
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37491 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:BURNEY
Mailing Address - State:CA
Mailing Address - Zip Code:96013-4379
Mailing Address - Country:US
Mailing Address - Phone:530-999-9030
Mailing Address - Fax:530-335-3060
Practice Address - Street 1:37491 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:BURNEY
Practice Address - State:CA
Practice Address - Zip Code:96013-4379
Practice Address - Country:US
Practice Address - Phone:530-999-9030
Practice Address - Fax:530-335-3060
Is Sole Proprietor?:No
Enumeration Date:2014-07-11
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95006454363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP95006454OtherFAMILY AND MENTAL HEALTH NURSE PRACTITIONER