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: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 S VERMONT AVE
LOS ANGELES CA
90020-1912
US

IV. Provider business mailing address

510 S VERMONT AVE
LOS ANGELES CA
90020-1912
US

V. Phone/Fax

Practice location:
  • Phone: 213-738-2877
  • Fax:
Mailing address:
  • Phone: 213-738-2877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: