Provider Demographics
NPI:1447637392
Name:LEE, DAVID CHONG HYUN (CRNA)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:CHONG HYUN
Last Name:LEE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:MR
Other - First Name:DAVID
Other - Middle Name:CHONG HYUN
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:538 S OAKLAND AVE
Mailing Address - Street 2:APT 304
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-4017
Mailing Address - Country:US
Mailing Address - Phone:808-224-0083
Mailing Address - Fax:
Practice Address - Street 1:18880 BRASILIA DR
Practice Address - Street 2:
Practice Address - City:PORTER RANCH
Practice Address - State:CA
Practice Address - Zip Code:91326-1950
Practice Address - Country:US
Practice Address - Phone:808-224-0083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-29
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA839542163W00000X
HI61834163W00000X
CA95000324367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse