MEDICARE: JANE JINKYUNG LEE

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	LMFT148459	CA
2	101YP2500X	Professional Counselor	LPCC17240	CA

General Provider Information

NPI Number	:	1396403473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE JINKYUNG LEE

Provider Business Mailing Address
First Line	:	PO BOX 6833
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90504-0833
Country	:	US
Telephone Number	:	213-507-6879
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 REDONDO AVE FL 6
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-2325
Country	:	US
Telephone Number	:	562-256-2960
Fax Number	:

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

Provider Enumeration Date	:	12/06/2021
Last Update Date	:	06/06/2026

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