Active NPI
Suyeon Lee
- Pediatric Clinical Nurse Specialist
- Garden Grove, CA
National Provider Identifier
1821457607
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Clinical Nurse Specialist
- License
- 95003748
- Practice address
- 12112 Adrian St
#6-112
Garden Grove, CA 92840-4352 - Phone
- (213) 379-3095
- NPI assigned
- Feb 22, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Clinical Nurse Specialist | 364SP0200X | 95003748 | CA | Primary |
Addresses
Primary practice location
12112 Adrian St
#6-112
Garden Grove, CA 92840-4352
Mailing address
12112 Adrian St
#6-112
Garden Grove, CA 92840-4352
Phone (213) 379-3095
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95003748 | CA | MD | Pediatric Clinical Nurse Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1456099200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1456099200000",
"number": "1821457607",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12112 ADRIAN ST",
"address_2": "#6-112",
"city": "GARDEN GROVE",
"state": "CA",
"postal_code": "928404352",
"telephone_number": "213-379-3095"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12112 ADRIAN ST",
"address_2": "#6-112",
"city": "GARDEN GROVE",
"state": "CA",
"postal_code": "928404352",
"telephone_number": "213-379-3095"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "SUYEON",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-02-22",
"last_updated": "2016-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "364SP0200X",
"taxonomy_group": "",
"desc": "Clinical Nurse Specialist, Pediatrics",
"state": "CA",
"license": "95003748",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Garden Grove, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.