Healthcare Provider Details

I. General information

NPI: 1194477877
Provider Name (Legal Business Name): SOJUNG LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STACY LEE

II. Dates (important events)

Enumeration Date: 01/24/2022
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6833 STOCKTON BLVD STE 485
SACRAMENTO CA
95823-2376
US

IV. Provider business mailing address

6833 STOCKTON BLVD STE 485
SACRAMENTO CA
95823-2376
US

V. Phone/Fax

Practice location:
  • Phone: 916-827-5937
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number151493
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: