Provider Demographics
NPI:1689400012
Name:LEE, DEBORAH EUN-JI (FNP-C)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:EUN-JI
Last Name:LEE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 ENTERPRISE APT 3216
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-7124
Mailing Address - Country:US
Mailing Address - Phone:818-306-6472
Mailing Address - Fax:
Practice Address - Street 1:16100 SAND CANYON AVE STE 240
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3724
Practice Address - Country:US
Practice Address - Phone:949-393-7443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95030752363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily