Healthcare Provider Details

I. General information

NPI: 1467540690
Provider Name (Legal Business Name): C. K. ESTHER LEE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHOON KANG LEE PH.D.

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 REDONDO AVE FL 6
LONG BEACH CA
90806-2325
US

IV. Provider business mailing address

510 S VERMONT AVE
LOS ANGELES CA
90020-1912
US

V. Phone/Fax

Practice location:
  • Phone: 213-332-2627
  • Fax:
Mailing address:
  • Phone: 213-332-2627
  • Fax: 213-332-2627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY17530
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY17530
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: