Basic Information
| Provider Information | |||||||||
| NPI: | 1710444377 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | JONGHYEOK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1665 W ADAMS BLVD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900071533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237313534 | ||||||||
| FaxNumber: | 3237315618 | ||||||||
| Practice Location | |||||||||
| Address1: | 1968 W ADAMS BLVD # 101 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900183515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237313534 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2019 | ||||||||
| LastUpdateDate: | 09/22/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 85457 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.