Healthcare Provider Details

I. General information

NPI: 1942872544
Provider Name (Legal Business Name): DONG EUN LEE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13236 MURANO AVE
CHINO CA
91710-8116
US

IV. Provider business mailing address

13236 MURANO AVE
CHINO CA
91710-8116
US

V. Phone/Fax

Practice location:
  • Phone: 310-929-0686
  • Fax: 310-731-1168
Mailing address:
  • Phone: 310-929-0686
  • Fax: 310-731-1168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number150360
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: