Healthcare Provider Details

I. General information

NPI: 1417617614
Provider Name (Legal Business Name): HYEJIN GRACE LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GRACE LEE

II. Dates (important events)

Enumeration Date: 12/29/2021
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3223 W 6TH ST STE 101
LOS ANGELES CA
90020-5000
US

IV. Provider business mailing address

3223 W 6TH ST STE 101
LOS ANGELES CA
90020-5000
US

V. Phone/Fax

Practice location:
  • Phone: 213-545-1518
  • Fax:
Mailing address:
  • Phone: 213-545-1518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW100331
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: