Healthcare Provider Details

I. General information

NPI: 1396403473
Provider Name (Legal Business Name): JANE JINKYUNG LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

PO BOX 6833
TORRANCE CA
90504-0833
US

V. Phone/Fax

Practice location:
  • Phone: 562-256-2960
  • Fax:
Mailing address:
  • Phone: 213-507-6879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT148459
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC17240
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: