Provider Demographics
NPI:1538780218
Name:LEE, LAIN L (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:LAIN
Middle Name:L
Last Name:LEE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:18000 STUDEBAKER RD STE 800
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2671
Mailing Address - Country:US
Mailing Address - Phone:562-735-3226
Mailing Address - Fax:562-869-1281
Practice Address - Street 1:8135 PAINTER AVE STE 103
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-3171
Practice Address - Country:US
Practice Address - Phone:562-698-6888
Practice Address - Fax:562-698-5255
Is Sole Proprietor?:No
Enumeration Date:2020-05-04
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95014078363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0052990Medicaid
CA954430908Medicaid