MEDICARE: DR. JULIE HAE BIN KWON LEE PH.D., M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	91277	CA

General Provider Information

NPI Number	:	1134373038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIE HAE BIN KWON LEE PH.D., M.S.

Provider Business Mailing Address
First Line	:	170 E YORBA LINDA BLVD # 308
Second Line	:
City	:	PLACENTIA
State	:	CA
Zip	:	92870-3327
Country	:	US
Telephone Number	:	657-315-3940
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 S KRAEMER BLVD STE 208
Second Line	:
City	:	PLACENTIA
State	:	CA
Zip	:	92870-6110
Country	:	US
Telephone Number	:	657-315-3940
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2008
Last Update Date	:	07/28/2024

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