Healthcare Provider Details

I. General information

NPI: 1023853256
Provider Name (Legal Business Name): PEARL YEAWON LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2024
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8635 W 3RD ST STE 590W
LOS ANGELES CA
90048-6163
US

IV. Provider business mailing address

4140 W 190TH ST
TORRANCE CA
90504-5513
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-1220
  • Fax: 310-423-1230
Mailing address:
  • Phone: 310-423-1220
  • Fax: 310-423-1230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number3904
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: