Healthcare Provider Details

I. General information

NPI: 1023636354
Provider Name (Legal Business Name): JUNG WON LEE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HANNAH LEE

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 N HANDY ST
ORANGE CA
92867-4434
US

IV. Provider business mailing address

1401 N HANDY ST
ORANGE CA
92867-4434
US

V. Phone/Fax

Practice location:
  • Phone: 714-628-4080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number20039
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: