MEDICARE: HOSUK LEE OTR

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	225X00000X	Occupational Therapist	OT 8004	CA

General Provider Information

NPI Number	:	1619019445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOSUK LEE OTR

Provider Business Mailing Address
First Line	:	1206 S VICTORIA AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-3155
Country	:	US
Telephone Number	:	213-820-9546
Fax Number	:

Provider Business Practice Location Address
First Line	:	8121 VAN NUYS BLVD
Second Line	:	SUITE 510
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-5105
Country	:	US
Telephone Number	:	818-392-8115
Fax Number	:	818-357-5574

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

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	11/29/2021

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