Healthcare Provider Details

I. General information

NPI: 1780709253
Provider Name (Legal Business Name): BUM SOO LEE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 S ANAHEIM BLVD
ANAHEIM CA
92805-5851
US

IV. Provider business mailing address

179 S PERALTA HILLS DR
ANAHEIM CA
92807-3424
US

V. Phone/Fax

Practice location:
  • Phone: 714-270-0684
  • Fax: 714-999-6686
Mailing address:
  • Phone: 714-974-7368
  • Fax: 714-999-6686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: DR. BUM SOO LEE
Title or Position: STAFF PSYCHIATRIST
Credential: M.D.
Phone: 714-279-0684