Provider Demographics
NPI:1679464614
Name:KANG, MINJI LEE (FNP)
Entity type:Individual
Prefix:
First Name:MINJI
Middle Name:LEE
Last Name:KANG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16289 DAWN WAY UNIT 105
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-2861
Mailing Address - Country:US
Mailing Address - Phone:213-434-2848
Mailing Address - Fax:
Practice Address - Street 1:15415 JEFFREY RD STE 102
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-4103
Practice Address - Country:US
Practice Address - Phone:626-532-3231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95188868163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse