Healthcare Provider Details

I. General information

NPI: 1639015209
Provider Name (Legal Business Name): JIN LEE PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 S CATALINA ST
LOS ANGELES CA
90005-1943
US

IV. Provider business mailing address

701 S CATALINA ST
LOS ANGELES CA
90005-1943
US

V. Phone/Fax

Practice location:
  • Phone: 408-800-8670
  • Fax:
Mailing address:
  • Phone: 408-800-8670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4841
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: