1548755747 NPI number — HYUNHYE LEE DPT

Table of content: HYUNHYE LEE DPT (NPI 1548755747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548755747 NPI number — HYUNHYE LEE DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
HYUNHYE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548755747
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 SOQUEL WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUNNYVALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94085-4102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-736-7600
Provider Business Mailing Address Fax Number:
408-736-7604

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 SOQUEL WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUNNYVALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94085-4102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-736-7600
Provider Business Practice Location Address Fax Number:
408-736-7604
Provider Enumeration Date:
06/29/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT294892 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1053320325 . This is a "GROUP NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZ29361Z . This is a "GROUP MC PTAN" identifier . This identifiers is of the category "OTHER".