Healthcare Provider Details

I. General information

NPI: 1942937792
Provider Name (Legal Business Name): SEULBI LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 W SUNSET BLVD STE C110
LOS ANGELES CA
90046-2439
US

IV. Provider business mailing address

1 PACE PLZ
NEW YORK NY
10038-1502
US

V. Phone/Fax

Practice location:
  • Phone: 213-412-0400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number61767
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: